Healthcare Provider Details

I. General information

NPI: 1841066743
Provider Name (Legal Business Name): LEWIS A MAZZONE JR. MA, SSP, BCBA, NCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4823 ROLLING GREEN DR
WESLEY CHAPEL FL
33543-7044
US

IV. Provider business mailing address

4823 ROLLING GREEN DR
WESLEY CHAPEL FL
33543-7044
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-7543
  • Fax:
Mailing address:
  • Phone: 516-395-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: