Healthcare Provider Details

I. General information

NPI: 1164702338
Provider Name (Legal Business Name): BONNIE MAZZEI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 CURWOOD ST
WATERFORD MI
48329-4012
US

IV. Provider business mailing address

6228 BALMORAL TER
CLARKSTON MI
48346-3341
US

V. Phone/Fax

Practice location:
  • Phone: 248-830-7901
  • Fax:
Mailing address:
  • Phone: 248-795-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802087045
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: