Provider Demographics
NPI:1104101203
Name:RAZZI, DEIRDRE (LSW)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:RAZZI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E. LANCASTER AVENUE
Mailing Address - Street 2:APT. 616
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3220
Mailing Address - Country:US
Mailing Address - Phone:215-287-4742
Mailing Address - Fax:
Practice Address - Street 1:850 W LANCASTER AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3220
Practice Address - Country:US
Practice Address - Phone:610-520-1510
Practice Address - Fax:610-520-1517
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical