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General NPI Number Information
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NPI Number | 1972510568
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Entity Type | Individual
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Provider Name | KENNETH PHILLIP BUZZELLI LISW LICDC
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 1865 BAILEY RD
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44221-5211
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Country | US
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Telephone | 330-928-2042
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Fax |
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Provider Business Mailing Address
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Address Line | 24400 HIGHPOINT RD SUITE #6
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City | BEACHWOOD
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State | OH
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Zip | 44124
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Country | US
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Telephone | 216-831-6550
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Fax | 216-831-6133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0001123
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0001123
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License Number State | OH
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