Provider Demographics
NPI:1639617426
Name:BUZZITTA, CHELSEA (MA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BUZZITTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:KNEIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6548 TOWN CENTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4823
Mailing Address - Country:US
Mailing Address - Phone:800-693-1916
Mailing Address - Fax:
Practice Address - Street 1:6548 TOWN CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4823
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018032103T00000X
MI6301016892103TC0700X
MI6361000541103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical