Provider Demographics
NPI:1073149795
Name:BAZZINOTTI, JOANNA THERESE
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:THERESE
Last Name:BAZZINOTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2526
Mailing Address - Country:US
Mailing Address - Phone:978-835-5167
Mailing Address - Fax:
Practice Address - Street 1:129 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2526
Practice Address - Country:US
Practice Address - Phone:978-835-5167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst