Healthcare Provider Details

I. General information

NPI: 1750459798
Provider Name (Legal Business Name): JEANNINE MARIE RIZZO LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 5TH AVENUE
BAYSHORE NY
11706
US

IV. Provider business mailing address

790 PARK AVE
HUNTINGTON NY
11743-4516
US

V. Phone/Fax

Practice location:
  • Phone: 631-647-3100
  • Fax: 631-647-3130
Mailing address:
  • Phone: 631-427-3700
  • Fax: 631-427-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0742451
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: