Basic Information
| Provider Information | |||||||||
| NPI: | 1033725569 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEIRDRE RAZZI, LCSW, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 W PLUMSTEAD AVE | ||||||||
| Address2: | |||||||||
| City: | LANSDOWNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190501120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152874742 | ||||||||
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| Practice Location | |||||||||
| Address1: | 207 W PLUMSTEAD AVE | ||||||||
| Address2: | |||||||||
| City: | LANSDOWNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190501120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152874742 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2020 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAZZI | ||||||||
| AuthorizedOfficialFirstName: | DEIRDRE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, SOLE PRACTIONER | ||||||||
| AuthorizedOfficialTelephone: | 2152874742 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 102L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychoanalyst |
No ID Information.