Healthcare Provider Details

I. General information

NPI: 1891562377
Provider Name (Legal Business Name): SARA MAZZULLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 S BELLAIRE ST STE 390
DENVER CO
80222-4350
US

IV. Provider business mailing address

1777 S BELLAIRE ST STE 390
DENVER CO
80222-4350
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-4244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0009925116
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: