Provider Demographics
NPI:1720673841
Name:PEZZULLO, DAVID LAWRENCE (MHCI)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LAWRENCE
Last Name:PEZZULLO
Suffix:
Gender:M
Credentials:MHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6884 LONE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-6806
Mailing Address - Country:US
Mailing Address - Phone:786-395-9254
Mailing Address - Fax:
Practice Address - Street 1:6884 LONE OAK BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-6806
Practice Address - Country:US
Practice Address - Phone:786-395-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41912101YM0800X
FL9875703101YM0800X
FL20341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health