MEDICARE: DR. LISA ANNE MAZZIO PSY.D, LCP

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	103TC0700X	Clinical Psychologist	0810004778	VA

General Provider Information

NPI Number	:	1992145338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ANNE MAZZIO PSY.D, LCP

Provider Business Mailing Address
First Line	:	1600 COLONIAL AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2020
Country	:	US
Telephone Number	:	757-354-1422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 COLONIAL AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2020
Country	:	US
Telephone Number	:	757-354-1422
Fax Number	:

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

Provider Enumeration Date	:	06/30/2013
Last Update Date	:	06/30/2013

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