Provider Demographics
NPI:1699117317
Name:RIZZO, JOSEPH RICHARD (PHD, LP, CAADC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RICHARD
Last Name:RIZZO
Suffix:
Gender:
Credentials:PHD, LP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S STATE ST STE 4079
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1303
Mailing Address - Country:US
Mailing Address - Phone:734-764-8312
Mailing Address - Fax:
Practice Address - Street 1:23810 MICHIGAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1830
Practice Address - Country:US
Practice Address - Phone:313-359-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 247200000X
MI6301016222103T00000X, 103TC0700X
MI6301019534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other