Provider Demographics
NPI:1245976059
Name:COCOZZELLA, CLARISSA (DACM, LAC)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:COCOZZELLA
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 YAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2516
Mailing Address - Country:US
Mailing Address - Phone:303-829-0737
Mailing Address - Fax:
Practice Address - Street 1:650 YAMPA AVE
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2516
Practice Address - Country:US
Practice Address - Phone:303-829-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002599171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist