Healthcare Provider Details

I. General information

NPI: 1972510568
Provider Name (Legal Business Name): KENNETH PHILLIP BUZZELLI LISW LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 BAILEY RD
CUYAHOGA FALLS OH
44221-5211
US

IV. Provider business mailing address

24400 HIGHPOINT RD SUITE #6
BEACHWOOD OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 330-928-2042
  • Fax:
Mailing address:
  • Phone: 216-831-6550
  • Fax: 216-831-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0001123
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0001123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: