Provider Demographics
NPI:1760220230
Name:PIZZUTO, KELLIE E (LPC)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:E
Last Name:PIZZUTO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHERWOOD DR STE D
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3086
Mailing Address - Country:US
Mailing Address - Phone:570-293-9044
Mailing Address - Fax:
Practice Address - Street 1:16 SHERWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3086
Practice Address - Country:US
Practice Address - Phone:570-258-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional