Provider Demographics
NPI:1922210061
Name:CANNIZZARO, MATTHEW (BA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CANNIZZARO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19671 E HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-9437
Mailing Address - Country:US
Mailing Address - Phone:303-523-3635
Mailing Address - Fax:
Practice Address - Street 1:6507 S SANTA FE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2910
Practice Address - Country:US
Practice Address - Phone:303-730-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099255601041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health