Provider Demographics
NPI:1740528694
Name:CAIAZZO, MICHAEL PATRICK (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:CAIAZZO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:405 E CHOCOLATE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1331
Mailing Address - Country:US
Mailing Address - Phone:717-495-9505
Mailing Address - Fax:717-533-2601
Practice Address - Street 1:405 E CHOCOLATE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1331
Practice Address - Country:US
Practice Address - Phone:717-495-9505
Practice Address - Fax:717-533-2601
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS017064103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist