Provider Demographics
NPI:1508843137
Name:RIAZZI, KELLY SUE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SUE
Last Name:RIAZZI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-0047
Mailing Address - Country:US
Mailing Address - Phone:814-796-0224
Mailing Address - Fax:
Practice Address - Street 1:110 W SMITH ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1558
Practice Address - Country:US
Practice Address - Phone:814-796-0224
Practice Address - Fax:814-796-0224
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW010418-L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker