Provider Demographics
NPI:1184497273
Name:DEMAIDA, REBECCA COLELLA (LPCA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:COLELLA
Last Name:DEMAIDA
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-1317
Mailing Address - Country:US
Mailing Address - Phone:203-508-5353
Mailing Address - Fax:
Practice Address - Street 1:1089B WOODTICK RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2123
Practice Address - Country:US
Practice Address - Phone:203-879-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health