Healthcare Provider Details

I. General information

NPI: 1750651386
Provider Name (Legal Business Name): MONICA RIZZUTO CRAIN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W I 240 SERVICE RD
OKLAHOMA CITY OK
73139-7701
US

IV. Provider business mailing address

300 ANNAWOOD DR
YUKON OK
73099-2002
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-0476
  • Fax:
Mailing address:
  • Phone: 620-506-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: