Provider Demographics
NPI:1053983585
Name:PEZZULO, ELIZA K (MFTA)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:K
Last Name:PEZZULO
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LOOMIS AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2418
Mailing Address - Country:US
Mailing Address - Phone:860-681-9971
Mailing Address - Fax:
Practice Address - Street 1:370 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1949
Practice Address - Country:US
Practice Address - Phone:860-515-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2608106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist