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Individual
MR. KENNETH PHILLIP BUZZELLI
Active
Individual
MR. KENNETH PHILLIP BUZZELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW LICDC
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0001123
OH
2084P0800X
Psychiatry Physician
0001123
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196677000
MAGELLAN
OH
01
—
343178
VALUE OPTIONS - FACILITY
OH
Enumeration date
08/03/2006
Last updated
07/03/2024
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