Provider Demographics
NPI:1831397322
Name:TELLECHEA, JOSE A
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:TELLECHEA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:ANTONIO
Other - Last Name:TELLECHEA-MENDOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:233 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4204
Mailing Address - Country:US
Mailing Address - Phone:860-826-1358
Mailing Address - Fax:860-229-8886
Practice Address - Street 1:233 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4204
Practice Address - Country:US
Practice Address - Phone:860-826-1358
Practice Address - Fax:860-229-8886
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT253032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry