Provider Demographics
NPI:1326680992
Name:PANZONE, JAMES DEREK (MSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DEREK
Last Name:PANZONE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BLUFF TER
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1316
Mailing Address - Country:US
Mailing Address - Phone:832-425-7615
Mailing Address - Fax:
Practice Address - Street 1:326 CROTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6340
Practice Address - Country:US
Practice Address - Phone:321-752-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical