Provider Demographics
NPI:1851394381
Name:CASAZZA, RALPH E (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:E
Last Name:CASAZZA
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 1:1917 TRIXIE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2631
Mailing Address - Country:US
Mailing Address - Phone:713-789-1692
Mailing Address - Fax:186-663-6669
Practice Address - Street 1:1917 TRIXIE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2631
Practice Address - Country:US
Practice Address - Phone:713-789-1692
Practice Address - Fax:186-663-6669
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26878103TC0700X, 103TA0700X, 103TH0100X, 103TB0200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1132425-03Medicaid
TX1132425-03Medicaid
TX00043EMedicare ID - Type Unspecified