Provider Demographics
NPI:1649529595
Name:RIZZO, NICOLE (LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RIZZO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 TORREMOLINOS AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:786-348-3672
Mailing Address - Fax:
Practice Address - Street 1:3332 TORREMOLINOS AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2955
Practice Address - Country:US
Practice Address - Phone:786-348-3672
Practice Address - Fax:786-348-3672
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3390101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health