Provider Demographics
NPI:1548670748
Name:RAMONDETTA, PATRICIA ELLEN
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:RAMONDETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ELLEN
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:150 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4152
Mailing Address - Country:US
Mailing Address - Phone:860-849-0599
Mailing Address - Fax:860-292-1671
Practice Address - Street 1:38 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-9679
Practice Address - Country:US
Practice Address - Phone:860-849-0599
Practice Address - Fax:860-292-1671
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000627101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)