Provider Demographics
NPI:1982956181
Name:COGDELL, BRITTANNI KORYN (LPC,MA,BA)
Entity Type:Individual
Prefix:
First Name:BRITTANNI
Middle Name:KORYN
Last Name:COGDELL
Suffix:
Gender:F
Credentials:LPC,MA,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:142 GRIGGS ST
Practice Address - Street 2:THERAPEUTIC SHELTER
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-3110
Practice Address - Country:US
Practice Address - Phone:203-574-3311
Practice Address - Fax:203-574-3315
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicaid
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
PENDINGOtherCAQH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CTPENDINGOtherOPTUM BEHAVIORAL HEALTH