Provider Demographics
NPI:1972510568
Name:BUZZELLI, KENNETH PHILLIP (LISW LICDC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:PHILLIP
Last Name:BUZZELLI
Suffix:
Gender:M
Credentials:LISW LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24400 HIGHPOINT RD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:216-831-6550
Mailing Address - Fax:216-831-6133
Practice Address - Street 1:1865 BAILEY RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5211
Practice Address - Country:US
Practice Address - Phone:330-928-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00011232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH196677000OtherMAGELLAN
OH343178OtherVALUE OPTIONS - FACILITY