Provider Demographics
NPI:1518081850
Name:BIZZARRO, JOSEPH BENJAMIN
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BENJAMIN
Last Name:BIZZARRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1318
Mailing Address - Country:US
Mailing Address - Phone:973-239-0011
Mailing Address - Fax:
Practice Address - Street 1:110 FAIRVIEW AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1318
Practice Address - Country:US
Practice Address - Phone:973-239-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist