Healthcare Provider Details

I. General information

NPI: 1760678866
Provider Name (Legal Business Name): LEA MAZZEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 STONY POINT RD
SANTA ROSA CA
95407-8080
US

IV. Provider business mailing address

PO BOX 1819
ROHNERT PARK CA
94927-1819
US

V. Phone/Fax

Practice location:
  • Phone: 707-585-3700
  • Fax:
Mailing address:
  • Phone: 707-585-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: