Provider Demographics
NPI:1477609675
Name:VIZZA, LAUREEN E (R-LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:E
Last Name:VIZZA
Suffix:
Gender:F
Credentials:R-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1133
Mailing Address - Country:US
Mailing Address - Phone:631-424-0506
Mailing Address - Fax:631-424-0506
Practice Address - Street 1:260 BAY AVE
Practice Address - Street 2:
Practice Address - City:HALESITE
Practice Address - State:NY
Practice Address - Zip Code:11743-1133
Practice Address - Country:US
Practice Address - Phone:631-424-0506
Practice Address - Fax:631-424-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035506-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2353944OtherOXFORD INSURANCE
NYN0J281Medicare PIN