Provider Demographics
NPI:1255719357
Name:RAZZANO, CONSTANCE (LMHC)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:RAZZANO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 NE SAGAMORE TER
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1262
Mailing Address - Country:US
Mailing Address - Phone:786-520-6527
Mailing Address - Fax:
Practice Address - Street 1:269 NE SAGAMORE TER
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1262
Practice Address - Country:US
Practice Address - Phone:786-520-6527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL360339300Medicaid