Provider Demographics
NPI:1245815703
Name:KOLA, ALBA (MA)
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:
Last Name:KOLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 TURNPIKE ST STE 1-3A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2700
Mailing Address - Country:US
Mailing Address - Phone:781-619-1500
Mailing Address - Fax:781-579-9479
Practice Address - Street 1:340 TURNPIKE ST STE 1-3A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2700
Practice Address - Country:US
Practice Address - Phone:781-619-1500
Practice Address - Fax:781-579-9479
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY10000728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical