Provider Demographics
NPI:1124047444
Name:RIZZO, THOMAS ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:RIZZO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4842
Mailing Address - Country:US
Mailing Address - Phone:630-955-9800
Mailing Address - Fax:630-420-3450
Practice Address - Street 1:624 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3237
Practice Address - Country:US
Practice Address - Phone:630-955-9800
Practice Address - Fax:630-420-3450
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19478Medicare PIN