Healthcare Provider Details

I. General information

NPI: 1780252148
Provider Name (Legal Business Name): CAZZIE ES STEINZOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 10/31/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY STREET POTTER 2
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

997 SAINT SEBASTIAN WAY
AUGUSTA GA
30912-2613
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-2128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS02214
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: