Provider Demographics
NPI:1669498143
Name:TELLA, ROBERT R (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:TELLA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 WASHINGTON ST
Mailing Address - Street 2:FRASER MEDICAL BUILDING, SUITE 375
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6219
Mailing Address - Country:US
Mailing Address - Phone:781-431-1173
Mailing Address - Fax:781-239-3661
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:FRASER MEDICAL BUILDING, SUITE 375
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-6219
Practice Address - Country:US
Practice Address - Phone:781-431-1173
Practice Address - Fax:781-239-3661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical