Basic Information
| Provider Information | |||||||||
| NPI: | 1508800558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLADA | ||||||||
| FirstName: | SLAVOMIR | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 W GATE DR | ||||||||
| Address2: | |||||||||
| City: | BOW | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033044102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032245215 | ||||||||
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| Practice Location | |||||||||
| Address1: | VAMC 718 SMYTH RD | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036244366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2415 | MA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.