Provider Demographics
NPI:1477164903
Name:PANZARELLA, MICHELLE LORRAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LORRAINE
Last Name:PANZARELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12579 HUNTINGTON TRCE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-7501
Mailing Address - Country:US
Mailing Address - Phone:770-355-5610
Mailing Address - Fax:
Practice Address - Street 1:12579 HUNTINGTON TRCE
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-7501
Practice Address - Country:US
Practice Address - Phone:770-355-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0049631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty