Healthcare Provider Details

I. General information

NPI: 1932287265
Provider Name (Legal Business Name): KELLIE CUZZOLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CLAREMONT AVE
COLONIA NJ
07067-2919
US

IV. Provider business mailing address

115 CLAREMONT AVE
COLONIA NJ
07067-2919
US

V. Phone/Fax

Practice location:
  • Phone: 732-259-5970
  • Fax:
Mailing address:
  • Phone: 732-259-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04740700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: