Provider Demographics
NPI:1295976363
Name:RIZZO, MATTHEW DAVID (LISW-S)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:RIZZO
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2801
Mailing Address - Country:US
Mailing Address - Phone:419-720-9247
Mailing Address - Fax:419-720-0304
Practice Address - Street 1:1822 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2801
Practice Address - Country:US
Practice Address - Phone:419-720-9247
Practice Address - Fax:419-720-0304
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.06001041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical