Healthcare Provider Details

I. General information

NPI: 1154531002
Provider Name (Legal Business Name): CHIARA LINDA NUZZO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 DEVON ST
PHILADELPHIA PA
19119-1709
US

IV. Provider business mailing address

7219 DEVON ST
PHILADELPHIA PA
19119-1709
US

V. Phone/Fax

Practice location:
  • Phone: 267-992-6956
  • Fax:
Mailing address:
  • Phone: 267-992-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS008221L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: