Basic Information
Provider Information
NPI: 1245587872
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDRIZZI
FirstName: YVETTE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
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Mailing Information
Address1: 18837 CLEARBROOK ST
Address2:  
City: PORTER RANCH
State: CA
PostalCode: 913262126
CountryCode: US
TelephoneNumber: 8186323667
FaxNumber:  
Practice Location
Address1: 7101 BAIRD AVE
Address2:  
City: RESEDA
State: CA
PostalCode: 913354150
CountryCode: US
TelephoneNumber: 8183425897
FaxNumber: 8189755008
Other Information
ProviderEnumerationDate: 08/14/2012
LastUpdateDate: 08/14/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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