MEDICARE: SALICIA ALANA MAZERO M.A, ATR, PLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2015007563	MO

General Provider Information

NPI Number	:	1376917278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALICIA ALANA MAZERO M.A, ATR, PLPC

Provider Business Mailing Address
First Line	:	4172 ITASKA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-2455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4172 ITASKA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-2455
Country	:	US
Telephone Number	:	314-329-5374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	11/16/2015

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