Basic Information
| Provider Information | |||||||||
| NPI: | 1225126014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRALEA | ||||||||
| FirstName: | CATALIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 399 SILVER STREET, P.O. BOX 351 | ||||||||
| Address2: | LEAK HALL/RVS | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602625200 | ||||||||
| FaxNumber: | 8602625316 | ||||||||
| Practice Location | |||||||||
| Address1: | 399 SILVER STREET, | ||||||||
| Address2: | LEAK HALL/RVS | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602625200 | ||||||||
| FaxNumber: | 8602625316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 040364 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 4014679 | 05 | CT | MEDICAID | 1403641 | 01 | CLINIC | OTHER | 4024972 | 05 | CT | MEDICAID |