Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301002416 | MI |
NPI | 1174709398 |
---|---|
Provider Name | Richard Rizzo |
First Address | Westland, MI 48185-5524 |
Second Address | Westland, MI 48185-5524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2008 |
Last Update Date | 17/01/2008 |