Provider Demographics
NPI:1871959460
Name:PETROZELLI, DANIELLE (MS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PETROZELLI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17925 33RD RD N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3616
Mailing Address - Country:US
Mailing Address - Phone:561-281-9234
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:17925 33RD RD N
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3616
Practice Address - Country:US
Practice Address - Phone:561-281-9234
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
FLLMH 13786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other