Provider Demographics
NPI:1356461263
Name:RAZZA, HEATHER LYN (LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYN
Last Name:RAZZA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4854
Mailing Address - Country:US
Mailing Address - Phone:401-595-4808
Mailing Address - Fax:401-294-3320
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:BUILDING D, SUITE 307D
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-294-3350
Practice Address - Fax:401-294-3320
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health