Provider Demographics
NPI:1851842322
Name:AZZARELLI, ITALA MARCELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:ITALA
Middle Name:MARCELLA
Last Name:AZZARELLI
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 1:3709 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4526
Mailing Address - Country:US
Mailing Address - Phone:919-444-1927
Mailing Address - Fax:919-681-5581
Practice Address - Street 1:2608 ERWIN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4596
Practice Address - Country:US
Practice Address - Phone:919-385-3232
Practice Address - Fax:919-681-5581
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0079151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical