Provider Demographics
NPI:1215646872
Name:RESILIENT RAZA PSYCHIATRY PROFESSIONAL LLC
Entity type:Organization
Organization Name:RESILIENT RAZA PSYCHIATRY PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAHREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-582-9308
Mailing Address - Street 1:304 WEST MAIN STREET, SUITE 2, # 138
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-919-6146
Mailing Address - Fax:
Practice Address - Street 1:900 STRAITS TURNPIKE, SUITE D
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2865
Practice Address - Country:US
Practice Address - Phone:860-919-6146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty