1346514429 NPI number — MRS. TAMMIE DIANE RIZZIO MSW, LGSW

Table of content: MRS. TAMMIE DIANE RIZZIO MSW, LGSW (NPI 1346514429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346514429 NPI number — MRS. TAMMIE DIANE RIZZIO MSW, LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIZZIO
Provider First Name:
TAMMIE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LGSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURPHY
Provider Other First Name:
TAMMIE
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LGSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346514429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
971 HARRISON AVE
Provider Second Line Business Mailing Address:
YOUTH HEALTH SERVICES, INC
Provider Business Mailing Address City Name:
ELKINS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-636-9450
Provider Business Mailing Address Fax Number:
304-636-2282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
971 HARRISON AVE
Provider Second Line Business Practice Location Address:
YOUTH HEALTH SERVICES, INC
Provider Business Practice Location Address City Name:
ELKINS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-636-9450
Provider Business Practice Location Address Fax Number:
304-636-2282
Provider Enumeration Date:
03/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  BP00943219 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0023397001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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