Healthcare Provider Details

I. General information

NPI: 1033725569
Provider Name (Legal Business Name): DEIRDRE RAZZI, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W PLUMSTEAD AVE
LANSDOWNE PA
19050-1120
US

IV. Provider business mailing address

207 W PLUMSTEAD AVE
LANSDOWNE PA
19050-1120
US

V. Phone/Fax

Practice location:
  • Phone: 215-287-4742
  • Fax:
Mailing address:
  • Phone: 215-287-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: MS. DEIRDRE RAZZI
Title or Position: OWNER, SOLE PRACTIONER
Credential: LCSW
Phone: 215-287-4742