Provider Demographics
NPI:1376844423
Name:O'DEA, MATTHEW J (BA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:O'DEA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LONGATE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1343
Mailing Address - Country:US
Mailing Address - Phone:860-539-0502
Mailing Address - Fax:
Practice Address - Street 1:48 HOWE ST STE 14
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4620
Practice Address - Country:US
Practice Address - Phone:860-539-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor