Provider Demographics
NPI:1336255454
Name:BORZELLINO, DAVID (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BORZELLINO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 HIGHLAND AVE BLDG BOFFICEA
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2527
Mailing Address - Country:US
Mailing Address - Phone:203-232-0955
Mailing Address - Fax:860-225-4642
Practice Address - Street 1:416 HIGHLAND AVE BLDG BOFFICEA
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2527
Practice Address - Country:US
Practice Address - Phone:203-232-0955
Practice Address - Fax:860-225-4642
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000771OtherMFT