Provider Demographics
NPI:1043853641
Name:IMPELLIZZERI, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:IMPELLIZZERI
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 1:21 COOL SPRING LN
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4648
Mailing Address - Country:US
Mailing Address - Phone:201-807-9275
Mailing Address - Fax:
Practice Address - Street 1:21 COOL SPRING LN
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4648
Practice Address - Country:US
Practice Address - Phone:301-807-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009454401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty