Provider Demographics
NPI:1346514429
Name:RIZZIO, TAMMIE DIANE (MSW, LGSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:DIANE
Last Name:RIZZIO
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:DIANE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LGSW
Mailing Address - Street 1:971 HARRISON AVE
Mailing Address - Street 2:YOUTH HEALTH SERVICES, INC
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-636-9450
Mailing Address - Fax:304-636-2282
Practice Address - Street 1:971 HARRISON AVE
Practice Address - Street 2:YOUTH HEALTH SERVICES, INC
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-9450
Practice Address - Fax:304-636-2282
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943219104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023397001Medicaid