| Doctor Name: | DR. JENA ELISE IANNUZZELLI |
| NPI Number: | 1053633131 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | B1-0000783 |
| Business Practice Address: | 331 W State St Media, PA - 190632615 |
| Business Phone Number: | 6105650515 |
| Business Fax Number: | 6105664141 |
| Mailing Address: | 331 W State St, MEDIA |
| State: | PA |
| Postal Code: | 190632615 |
| Phone Number: | 6105650515 |
| Fax Number: | 6105664141 |
| NPI Enumeration Date: | 02/17/2010 |
| NPI Last Update Date: | 02/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | B1-0000783 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | DE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |