Provider Demographics
NPI:1669878401
Name:TRAZI, MICHAEL SCOTT (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:TRAZI
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HOLDEN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5757
Mailing Address - Country:US
Mailing Address - Phone:401-274-1122
Mailing Address - Fax:401-453-7697
Practice Address - Street 1:65 VILLAGE SQUARE DR STE 302
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-2569
Practice Address - Country:US
Practice Address - Phone:401-530-5090
Practice Address - Fax:401-572-3364
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN47243163W00000X
RIAPRN01048363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse