MEDICARE: MS. PAMELA JEAN MAZZA LMHC

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	13409	FL
2	101YM0800X	Mental Health Counselor	9479	MA
3	101YS0200X	School Counselor	822222	NY
4	101YM0800X	Mental Health Counselor	004544	NY

General Provider Information

NPI Number	:	1962752014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA JEAN MAZZA LMHC

Provider Business Mailing Address
First Line	:	7136 BONITA DR APT 8
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3067
Country	:	US
Telephone Number	:	212-466-6432
Fax Number	:

Provider Business Practice Location Address
First Line	:	7136 BONITA DR APT 8
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3067
Country	:	US
Telephone Number	:	917-843-6981
Fax Number	:

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

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	04/14/2022

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