Healthcare Provider Details

I. General information

NPI: 1346514429
Provider Name (Legal Business Name): TAMMIE DIANE RIZZIO MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMIE DIANE MURPHY MSW, LGSW

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 HARRISON AVE YOUTH HEALTH SERVICES, INC
ELKINS WV
26241
US

IV. Provider business mailing address

971 HARRISON AVE YOUTH HEALTH SERVICES, INC
ELKINS WV
26241
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-9450
  • Fax: 304-636-2282
Mailing address:
  • Phone: 304-636-9450
  • Fax: 304-636-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00943219
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: