Individual
NICOLE FODASKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1428 MILLBROOK RD, MIDDLETOWN, CT 06457-5538
(860) 803-9678
Mailing address
1428 MILLBROOK RD, MIDDLETOWN, CT 06457-5538
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
003367
CT
Other
Enumeration date
09/24/2018
Last updated
09/24/2018
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