Provider Demographics
NPI:1568875011
Name:VIZZO, ANGELA M (MA, LMHC)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:M
Last Name:VIZZO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BETHANY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3305
Mailing Address - Country:US
Mailing Address - Phone:774-437-8370
Mailing Address - Fax:
Practice Address - Street 1:239 MILL ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3191
Practice Address - Country:US
Practice Address - Phone:774-437-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health