Provider Demographics
NPI:1356650659
Name:RIZZO, THERESA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:L
Last Name:RIZZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 TELEGRAPH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2072
Mailing Address - Country:US
Mailing Address - Phone:510-629-1770
Mailing Address - Fax:
Practice Address - Street 1:5925 W LAS POSITAS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8537
Practice Address - Country:US
Practice Address - Phone:925-249-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23837103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist