Healthcare Provider Details

I. General information

NPI: 1114230257
Provider Name (Legal Business Name): STEPHANIE MW VAZZANO MS, LCMHC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GREEN ST
CONCORD NH
03301-4000
US

IV. Provider business mailing address

21 GREEN ST
CONCORD NH
03301-4000
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2985
  • Fax:
Mailing address:
  • Phone: 603-225-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number994
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: