Provider Demographics
NPI:1093854184
Name:RIZZO STEVENSON, KAREN LEE (M ED)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:RIZZO STEVENSON
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:MISS
Other - First Name:KARE
Other - Middle Name:LEE
Other - Last Name:RIZZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:210 MEADOWCROFT LANE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-864-9296
Mailing Address - Fax:610-876-9844
Practice Address - Street 1:210 MEADOWCROFT LANE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-864-9296
Practice Address - Fax:610-876-9844
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00354800101YP2500X
PAPS 007354 L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MHS IBC 2247 466000OtherINDEP BL CR BLUE SHIELD