Provider Demographics
NPI:1629392519
Name:ZANNELLA, JOSEPH (LADC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ZANNELLA
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BLUE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2053
Mailing Address - Country:US
Mailing Address - Phone:203-362-8369
Mailing Address - Fax:
Practice Address - Street 1:2 OLD NEW MILFORD RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-362-8369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-21
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000637101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)