Provider Demographics
NPI:1922219542
Name:DAZZO, BARBARA B (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:DAZZO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CLYDE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-568-9998
Mailing Address - Fax:732-568-1961
Practice Address - Street 1:31 CLYDE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-568-9998
Practice Address - Fax:732-568-1961
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00283700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
850291Medicare ID - Type Unspecified