Healthcare Provider Details

I. General information

NPI: 1245778547
Provider Name (Legal Business Name): KELLY BIZZARRO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 VISTA PKWY STE 300
WEST PALM BEACH FL
33411-2706
US

IV. Provider business mailing address

2101 VISTA PKWY STE 300
WEST PALM BEACH FL
33411-2706
US

V. Phone/Fax

Practice location:
  • Phone: 561-452-6567
  • Fax:
Mailing address:
  • Phone: 561-452-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW10062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: