Provider Demographics
NPI:1174201313
Name:KALALA, TSHIBANGU CAMIL
Entity type:Individual
Prefix:MR
First Name:TSHIBANGU
Middle Name:CAMIL
Last Name:KALALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 FREELAND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-3025
Mailing Address - Country:US
Mailing Address - Phone:135-222-6545
Mailing Address - Fax:
Practice Address - Street 1:47 FREELAND ST APT 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-3025
Practice Address - Country:US
Practice Address - Phone:135-222-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health