Provider Demographics
NPI:1710729413
Name:MASRI, RAZAN
Entity type:Individual
Prefix:
First Name:RAZAN
Middle Name:
Last Name:MASRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 MOUNT LANGLEY ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7674
Mailing Address - Country:US
Mailing Address - Phone:224-707-1098
Mailing Address - Fax:
Practice Address - Street 1:3432 W DIVERSEY AVE STE 22
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1221
Practice Address - Country:US
Practice Address - Phone:224-707-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist