Provider Demographics
NPI:1093851024
Name:IANNUZZELLI, JANE E (MA, MED)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:E
Last Name:IANNUZZELLI
Suffix:
Gender:F
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2615
Mailing Address - Country:US
Mailing Address - Phone:610-565-0515
Mailing Address - Fax:610-566-4141
Practice Address - Street 1:331 W STATE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2615
Practice Address - Country:US
Practice Address - Phone:610-565-0515
Practice Address - Fax:610-566-4141
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005034-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103TC0700XOtherCLINICAL PSYCHOLOGY