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NPI Code Detail

MEDICARE: JASON MUZZILLO, PLLC

MEDICARE: JASON MUZZILLO, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center
2261QM0855XAdolescent and Children Mental Health Clinic/Center
31041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336614072
Entity Type Code : Organization
Provider Name (Legal Business Name) : JASON MUZZILLO, PLLC
Provider Business Mailing Address
First Line : 168 E REYNOLDS RD STE 150
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-1360
Country : US
Telephone Number : 859-322-9222
Fax Number :
Provider Business Practice Location Address
First Line : 168 E REYNOLDS RD STE 150
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-1360
Country : US
Telephone Number : 859-305-1430
Fax Number :
Authorized Official
Title or Position : OWNER/EMPLOYEE
Name : JASON MUZZILLO
Credential : LCSW
Telephone Number : 859-305-1430
Provider Enumeration Date : 10/09/2018
Last Update Date : 10/15/2021

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