Provider Demographics
NPI:1417521980
Name:GAZZILLO, JENNA (MHC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GAZZILLO
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3700
Practice Address - Street 1:6 WELLNESS WAY STE 112
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2156
Practice Address - Country:US
Practice Address - Phone:518-881-1109
Practice Address - Fax:518-213-6985
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health