Provider Demographics
NPI:1427371491
Name:PRADELLA, MAURO
Entity Type:Individual
Prefix:
First Name:MAURO
Middle Name:
Last Name:PRADELLA
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 1:3793 N HAMPTON DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6104
Mailing Address - Country:US
Mailing Address - Phone:404-502-7399
Mailing Address - Fax:
Practice Address - Street 1:3793 N HAMPTON DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6104
Practice Address - Country:US
Practice Address - Phone:404-502-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling