Provider Demographics
NPI:1992789531
Name:PEZZULO, DANIEL J (PHD, ABSNP, LCSW)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:PEZZULO
Suffix:
Gender:M
Credentials:PHD, ABSNP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 ESTHER DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2047
Mailing Address - Country:US
Mailing Address - Phone:717-413-2731
Mailing Address - Fax:717-413-2731
Practice Address - Street 1:154 ESTHER DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2047
Practice Address - Country:US
Practice Address - Phone:717-413-2731
Practice Address - Fax:717-413-2731
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04043671103TS0200X
PACW0127741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA627225OtherBLUE SHIELD
PA627225OtherBLUE SHIELD
PA082189Medicare ID - Type Unspecified