Healthcare Provider Details

I. General information

NPI: 1447880505
Provider Name (Legal Business Name): LELA A BIZZARO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 S VOLUSIA AVE STE B4
ORANGE CITY FL
32763-7625
US

IV. Provider business mailing address

1317 EDGEWATER DR # 1769
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 321-578-7488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: