Healthcare Provider Details

I. General information

NPI: 1043440829
Provider Name (Legal Business Name): JON RIZK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 324
PASADENA CA
91101-2021
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 324
PASADENA CA
91101-2021
US

V. Phone/Fax

Practice location:
  • Phone: 818-839-1365
  • Fax: 626-385-4871
Mailing address:
  • Phone: 818-839-1365
  • Fax: 626-385-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29152
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number29152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: