Provider Demographics
NPI:1215455407
Name:RIZZO, GAIL PENNY
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:PENNY
Last Name:RIZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 UNION CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2948
Mailing Address - Country:US
Mailing Address - Phone:513-874-5699
Mailing Address - Fax:513-682-4230
Practice Address - Street 1:8940 UNION CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2948
Practice Address - Country:US
Practice Address - Phone:513-874-5699
Practice Address - Fax:513-682-4230
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.131080101YA0400X
KY163258101YA0400X
OHE.0500616-SUPV101YM0800X, 101YP2500X
KY103099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health