Provider Demographics
NPI:1659633402
Name:PETRIZZO, LORRAINE ELIZABETH (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ELIZABETH
Last Name:PETRIZZO
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HOUSTON CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1510
Mailing Address - Country:US
Mailing Address - Phone:516-314-1678
Mailing Address - Fax:
Practice Address - Street 1:300 GARDEN CITY PLZ STE 350
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3358
Practice Address - Country:US
Practice Address - Phone:516-747-9030
Practice Address - Fax:516-393-9116
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist