Healthcare Provider Details

I. General information

NPI: 1497178677
Provider Name (Legal Business Name): LISA MARIE ZUROLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE DI BENEDITTO .LCSW

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CHURCH ST SUITE 202
NAUGATUCK CT
06770-4180
US

IV. Provider business mailing address

175 CHURCH ST SUITE 202
NAUGATUCK CT
06770-4180
US

V. Phone/Fax

Practice location:
  • Phone: 203-723-8546
  • Fax:
Mailing address:
  • Phone: 203-723-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005576
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: