Provider Demographics
NPI:1023888294
Name:MUZZARELLI, SOPHIA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:MUZZARELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EASTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2203
Mailing Address - Country:US
Mailing Address - Phone:815-962-0871
Mailing Address - Fax:
Practice Address - Street 1:220 EASTON PKWY
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2203
Practice Address - Country:US
Practice Address - Phone:815-962-8071
Practice Address - Fax:815-962-7895
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health