Provider Demographics
NPI:1457601155
Name:MANCARELLA, KRISTA (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:MANCARELLA
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4149
Mailing Address - Country:US
Mailing Address - Phone:267-973-7891
Mailing Address - Fax:
Practice Address - Street 1:140 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4149
Practice Address - Country:US
Practice Address - Phone:267-973-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS0017749103TC0700X
CT3732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical