Provider Demographics
NPI:1255733440
Name:PIZZULI, MICHELLE LYNN (EDS)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:PIZZULI
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:GOOTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:1349 E 79TH ST
Mailing Address - Street 2:OFFICE OF PSYCHOLOGICAL SERVICES
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-2864
Mailing Address - Country:US
Mailing Address - Phone:216-307-3863
Mailing Address - Fax:216-523-6309
Practice Address - Street 1:5935 ACKLEY RD
Practice Address - Street 2:MOUND STEM
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-1162
Practice Address - Country:US
Practice Address - Phone:216-307-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3083828103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool