Healthcare Provider Details

I. General information

NPI: 1376758680
Provider Name (Legal Business Name): CHRISTIE JADE RIZZO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPPIN ST SUITE 204
PROVIDENCE RI
02903-4141
US

IV. Provider business mailing address

593 EDDY ST APC 978 A
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8945
  • Fax: 401-444-7865
Mailing address:
  • Phone: 401-444-4318
  • Fax: 401-444-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00981
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: