Provider Demographics
NPI:1962233304
Name:BAGARELLA, KATLYN
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:BAGARELLA
Suffix:
Gender:F
Credentials:
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 2558
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-2558
Mailing Address - Country:US
Mailing Address - Phone:631-972-4344
Mailing Address - Fax:
Practice Address - Street 1:1060 W. BEAVER CREEK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-949-7097
Practice Address - Fax:970-446-7205
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health