Provider Demographics
NPI:1275669269
Name:RAZZA, NANCY J (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:RAZZA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 WAYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3148
Mailing Address - Country:US
Mailing Address - Phone:732-264-9501
Mailing Address - Fax:
Practice Address - Street 1:1158 WAYSIDE RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07712-3148
Practice Address - Country:US
Practice Address - Phone:732-264-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SL00315900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S17614Medicare UPIN
504986CZZMedicare ID - Type Unspecified