Provider Demographics
NPI:1356554893
Name:RAZZANO, THERESA ANN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:RAZZANO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:LAZZARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:290 GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4791
Mailing Address - Country:US
Mailing Address - Phone:510-386-1892
Mailing Address - Fax:
Practice Address - Street 1:290 GRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4791
Practice Address - Country:US
Practice Address - Phone:510-386-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34608106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34608Medicaid