Provider Demographics
NPI:1477270288
Name:VIZZIELLO, KAITLYN MICHELE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:MICHELE
Last Name:VIZZIELLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MICHELE
Other - Last Name:LABBIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1401 KINGS HWY APT 314A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5389
Mailing Address - Country:US
Mailing Address - Phone:860-940-4775
Mailing Address - Fax:
Practice Address - Street 1:15 VALLEY DR
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5205
Practice Address - Country:US
Practice Address - Phone:860-940-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6730104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker