MEDICARE: TIMOTHY SCOTT RAZZA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY7239	FL

General Provider Information

NPI Number	:	1598856627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY SCOTT RAZZA PSY.D.

Provider Business Mailing Address
First Line	:	15490 NW 7TH AVE
Second Line	:	SUITE 207
City	:	MIAMI
State	:	FL
Zip	:	33169-6250
Country	:	US
Telephone Number	:	305-598-2441
Fax Number	:	305-598-7443

Provider Business Practice Location Address
First Line	:	11001 SW 76TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2669
Country	:	US
Telephone Number	:	305-598-2441
Fax Number	:	305-598-7443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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