Provider Demographics
NPI:1710053244
Name:RIZZO, SALVATORE JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:JOSEPH
Last Name:RIZZO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SUNNYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1614
Mailing Address - Country:US
Mailing Address - Phone:781-828-2237
Mailing Address - Fax:
Practice Address - Street 1:275 TURNPIKE ST
Practice Address - Street 2:STE 105
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2357
Practice Address - Country:US
Practice Address - Phone:781-821-3900
Practice Address - Fax:781-821-1743
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2031103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02333OtherBLUECROSSBLUESHIELD OF MA
MAW02333-68Medicare ID - Type UnspecifiedPSYCHOLOGY