Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 4027 | MA |
N | 101YS0200X | School Counselor | 365449 | MA |
N | 1041S0200X | School Social Worker | 365449 | MA |
NPI | 1205073749 |
---|---|
Provider Name | Mr. Jason Christian Ravizza |
First Address | Agawam, MA 01001 |
Second Address | Agawam, MA 01001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 20/01/2009 |