Healthcare Provider Details

I. General information

NPI: 1568002616
Provider Name (Legal Business Name): ANGELO RANNAZZISI PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST STE 301
PHILADELPHIA PA
19107-4405
US

IV. Provider business mailing address

833 CHESTNUT ST STE 301
PHILADELPHIA PA
19107-4405
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-9138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS018042
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: