Provider Demographics
NPI:1720029416
Name:IZZO, JOSEPH ANTHONY III (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:IZZO
Suffix:III
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1805
Mailing Address - Country:US
Mailing Address - Phone:202-939-7631
Mailing Address - Fax:202-939-7655
Practice Address - Street 1:1701 14TH ST NW
Practice Address - Street 2:2ND FLOOR, ROOM # 10
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4308
Practice Address - Country:US
Practice Address - Phone:202-939-7631
Practice Address - Fax:202-939-7655
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3024181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical