Provider Demographics
NPI:1578394508
Name:COCUZZA, MICHEL L (MED)
Entity type:Individual
Prefix:
First Name:MICHEL
Middle Name:L
Last Name:COCUZZA
Suffix:
Gender:X
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 METCALF ST
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-2221
Mailing Address - Country:US
Mailing Address - Phone:978-400-8907
Mailing Address - Fax:
Practice Address - Street 1:176 METCALF ST
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-2221
Practice Address - Country:US
Practice Address - Phone:978-400-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator