Healthcare Provider Details

I. General information

NPI: 1922710334
Provider Name (Legal Business Name): JOSEPH SALVATORE PETRIELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOE PETRIELLO

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN ST
NEW BRITAIN CT
06051-4204
US

IV. Provider business mailing address

110 MAPLE ST
SPRINGFIELD MA
01105-1864
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax: 860-224-6968
Mailing address:
  • Phone: 413-732-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: