Provider Demographics
NPI:1558694174
Name:CUZZILLO, SHAWNEE LW (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAWNEE
Middle Name:LW
Last Name:CUZZILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1826
Mailing Address - Country:US
Mailing Address - Phone:510-525-8013
Mailing Address - Fax:510-525-8013
Practice Address - Street 1:1304 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1826
Practice Address - Country:US
Practice Address - Phone:510-525-8013
Practice Address - Fax:510-525-8013
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical