Provider Demographics
NPI:1144428004
Name:PRUETT, KYLE DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DEAN
Last Name:PRUETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TRUMBULL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3023
Mailing Address - Country:US
Mailing Address - Phone:413-584-5811
Mailing Address - Fax:
Practice Address - Street 1:900 CHAPEL ST
Practice Address - Street 2:SUITE 1212
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2802
Practice Address - Country:US
Practice Address - Phone:203-777-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTA15783101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor