| Doctor Name: | DR. ROBERT R TELLA |
| NPI Number: | 1669498143 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.D. |
| License Number: | 6719 |
| Business Practice Address: | 332 Washington St Fraser Medical Building, Suite 375 Wellesley Hills, MA - 024816219 |
| Business Phone Number: | 7814311173 |
| Business Fax Number: | 7812393661 |
| Mailing Address: | 332 Washington St, Fraser Medical Building, Suite 375 WELLESLEY HILLS |
| State: | MA |
| Postal Code: | 024816219 |
| Phone Number: | 7814311173 |
| Fax Number: | 7812393661 |
| NPI Enumeration Date: | 07/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6719 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |