Provider Demographics
NPI:1811537210
Name:AZEVEDO FAMILY PSYCHOLOGY, PA
Entity Type:Organization
Organization Name:AZEVEDO FAMILY PSYCHOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-624-9561
Mailing Address - Street 1:1903 N HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3093
Mailing Address - Country:US
Mailing Address - Phone:919-624-9561
Mailing Address - Fax:919-404-7124
Practice Address - Street 1:1903 N HARRISON AVE STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3093
Practice Address - Country:US
Practice Address - Phone:919-624-9561
Practice Address - Fax:919-404-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty