Provider Demographics
NPI:1417052580
Name:MALLOZZI, ANDREA SUSAN WHYTE (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUSAN WHYTE
Last Name:MALLOZZI
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:SUSAN
Other - Last Name:WHYTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCC, LPC
Mailing Address - Street 1:53 WHITE BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-2209
Mailing Address - Country:US
Mailing Address - Phone:203-938-0288
Mailing Address - Fax:
Practice Address - Street 1:71 EAST AVE
Practice Address - Street 2:SUITE T
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4903
Practice Address - Country:US
Practice Address - Phone:203-857-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional