Healthcare Provider Details

I. General information

NPI: 1669514170
Provider Name (Legal Business Name): HAROLD JERRY MIZNER HAROLD MIZNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 NEW MEADOW RD
SWANSEA MA
02777-3347
US

IV. Provider business mailing address

52 WINTHROP ST
SEEKONK MA
02771-3723
US

V. Phone/Fax

Practice location:
  • Phone: 508-379-0780
  • Fax:
Mailing address:
  • Phone: 508-336-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6229
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: