Provider Demographics
NPI:1043519093
Name:KALEAB, ANTENEH TESFAY
Entity Type:Individual
Prefix:
First Name:ANTENEH
Middle Name:TESFAY
Last Name:KALEAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LENOX ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2666
Mailing Address - Country:US
Mailing Address - Phone:413-222-1918
Mailing Address - Fax:413-746-2024
Practice Address - Street 1:15 LENOX ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2666
Practice Address - Country:US
Practice Address - Phone:413-222-1918
Practice Address - Fax:413-746-2024
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker