Healthcare Provider Details

I. General information

NPI: 1487128484
Provider Name (Legal Business Name): CRISTINA ELEANOR ZURLIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SORRENTO RD
WALLINGFORD CT
06492-4857
US

IV. Provider business mailing address

17 SORRENTO RD
WALLINGFORD CT
06492-4857
US

V. Phone/Fax

Practice location:
  • Phone: 203-623-6326
  • Fax:
Mailing address:
  • Phone: 203-623-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number010439
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: