1255733440 NPI number — MRS. MICHELLE LYNN PIZZULI ED.S.

Table of content: MRS. MICHELLE LYNN PIZZULI ED.S. (NPI 1255733440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255733440 NPI number — MRS. MICHELLE LYNN PIZZULI ED.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIZZULI
Provider First Name:
MICHELLE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ED.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOOTS
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255733440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1349 E 79TH ST
Provider Second Line Business Mailing Address:
OFFICE OF PSYCHOLOGICAL SERVICES
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44103-2864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-307-3863
Provider Business Mailing Address Fax Number:
216-523-6309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5935 ACKLEY RD
Provider Second Line Business Practice Location Address:
MOUND STEM
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44105-1162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-307-3863
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  OH3083828 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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