Healthcare Provider Details

I. General information

NPI: 1497988208
Provider Name (Legal Business Name): JESSICA RUTH MAZGAJ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 SWEET HOME RD STE 3
AMHERST NY
14228-2331
US

IV. Provider business mailing address

2360 SWEET HOME RD STE 3
AMHERST NY
14228-2331
US

V. Phone/Fax

Practice location:
  • Phone: 716-202-8704
  • Fax:
Mailing address:
  • Phone: 716-202-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: