Provider Demographics
NPI:1255587960
Name:COLELLA, JOSEPH R (CAADE/AOD INTERN)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:COLELLA
Suffix:
Gender:M
Credentials:CAADE/AOD INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-0353
Mailing Address - Country:US
Mailing Address - Phone:650-726-3149
Mailing Address - Fax:
Practice Address - Street 1:225 CABRILLO HWY S
Practice Address - Street 2:#200A
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-8200
Practice Address - Country:US
Practice Address - Phone:650-726-6369
Practice Address - Fax:650-726-4963
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)