Provider Demographics
NPI:1427802636
Name:COLELLA, KYLE EDWARD
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:EDWARD
Last Name:COLELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OLDE ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5619
Mailing Address - Country:US
Mailing Address - Phone:603-512-0536
Mailing Address - Fax:
Practice Address - Street 1:360 ROUTE 101 STE 14C
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5046
Practice Address - Country:US
Practice Address - Phone:603-755-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health