Provider Demographics
NPI:1073122776
Name:PEZZULLO, MICHAEL (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PEZZULLO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10055 REEVESBURY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1422
Mailing Address - Country:US
Mailing Address - Phone:347-886-3710
Mailing Address - Fax:
Practice Address - Street 1:8271 MELROSE AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-6800
Practice Address - Country:US
Practice Address - Phone:213-640-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty