Provider Demographics
NPI:1154451920
Name:KOLODZIEJSKI, DENNIS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:KOLODZIEJSKI
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 1:1215 WILBRAHAM RD
Mailing Address - Street 2:WNEC BOX # 5001
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-2654
Mailing Address - Country:US
Mailing Address - Phone:413-782-1348
Mailing Address - Fax:413-796-2216
Practice Address - Street 1:1215 WILBRAHAM RD
Practice Address - Street 2:WNEC BOX # 5001
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-2654
Practice Address - Country:US
Practice Address - Phone:413-782-1348
Practice Address - Fax:413-796-2216
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA883103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist