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General NPI Number Information
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NPI Number | 1215577911
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Entity Type | Organization
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Legal Business Name | FOOTPRINT INITIATIVE, LLC
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 62 E GATE LN
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City | HAMDEN
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State | CT
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Zip | 06514-2231
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Country | US
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Telephone | 646-554-3741
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Fax |
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Provider Business Mailing Address
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Address Line | 62 E GATE LN
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City | HAMDEN
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State | CT
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Zip | 06514-2231
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Country | US
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Telephone | 646-554-3741
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MS. JESSICA L RIZZO
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Credential | LCSW
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Telephone | 646-554-3741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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