Provider Demographics
NPI:1598856627
Name:RAZZA, TIMOTHY SCOTT (PSYD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:RAZZA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15490 NW 7TH AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6250
Mailing Address - Country:US
Mailing Address - Phone:305-598-2441
Mailing Address - Fax:305-598-7443
Practice Address - Street 1:11001 SW 76TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2669
Practice Address - Country:US
Practice Address - Phone:305-598-2441
Practice Address - Fax:305-598-7443
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7239103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist