Provider Demographics
NPI:1548479371
Name:KODA, VIVIAN HUHN (PHD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:HUHN
Last Name:KODA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 EAST AVE
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5738
Mailing Address - Country:US
Mailing Address - Phone:203-854-6900
Mailing Address - Fax:203-854-9301
Practice Address - Street 1:128 EAST AVE
Practice Address - Street 2:SUITE 1N
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5738
Practice Address - Country:US
Practice Address - Phone:203-854-6900
Practice Address - Fax:203-854-9301
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002471103G00000X, 103T00000X
NY015532103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist