Healthcare Provider Details

I. General information

NPI: 1154241917
Provider Name (Legal Business Name): LILLIAN MARY VOZZOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 NEWGATE RD
WEST SUFFIELD CT
06093-3011
US

IV. Provider business mailing address

849 NEWGATE RD
WEST SUFFIELD CT
06093-3011
US

V. Phone/Fax

Practice location:
  • Phone: 860-573-2267
  • Fax:
Mailing address:
  • Phone: 860-547-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberE55917
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: