Provider Demographics
NPI:1952779241
Name:PETELA, KIRSTIN (MS)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:PETELA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2367
Mailing Address - Country:US
Mailing Address - Phone:860-793-3871
Mailing Address - Fax:860-793-3369
Practice Address - Street 1:74 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2367
Practice Address - Country:US
Practice Address - Phone:860-793-3871
Practice Address - Fax:860-793-3369
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health