| Doctor Name: | MR. JASON CHRISTIAN RAVIZZA |
| NPI Number: | 1205073749 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED.,LMHC |
| License Number: | 365449 |
| Business Practice Address: | 200 Silver St. (agawam Crossing) Suite 106 Agawam, MA - 01001 |
| Business Phone Number: | 4137899198 |
| Business Fax Number: | 4137896322 |
| Mailing Address: | 200 Silver St,, Unit 106 AGAWAM |
| State: | MA |
| Postal Code: | 01001 |
| Phone Number: | 4137899198 |
| Fax Number: | 4137896322 |
| NPI Enumeration Date: | 01/20/2009 |
| NPI Last Update Date: | 01/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | 365449 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |