Provider Demographics
NPI:1639532427
Name:NIZNIK, ROSEMARIE
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:NIZNIK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:FRAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5708 GLEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6800 PARAGON PL STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1652
Practice Address - Country:US
Practice Address - Phone:804-562-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
VA0133002877103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP900868052Medicaid
VADM41-0141Medicaid
VA8744615Medicaid
VA1639532427Medicaid
VA3001768900Medicaid