Healthcare Provider Details

I. General information

NPI: 1033054226
Provider Name (Legal Business Name): JUSTINA MAZZELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 LAWLEY DR
LINCROFT NJ
07738-1560
US

IV. Provider business mailing address

610 LINCOLN BLVD
MIDDLESEX NJ
08846-2443
US

V. Phone/Fax

Practice location:
  • Phone: 732-856-1375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01237600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: