Provider Demographics
NPI:1720547631
Name:RIZZO, DONNA MARIE (MSED, PD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:RIZZO
Suffix:
Gender:F
Credentials:MSED, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CORTELYOU RD APT 5N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-6308
Mailing Address - Country:US
Mailing Address - Phone:917-613-9047
Mailing Address - Fax:
Practice Address - Street 1:10818 QUEENS BLVD FL 5
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4748
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:888-975-7704
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1305549103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool