Healthcare Provider Details

I. General information

NPI: 1396604161
Provider Name (Legal Business Name): MAZOL GAVRELOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 59TH ST APT 2R
BROOKLYN NY
11219-4995
US

IV. Provider business mailing address

1160 59TH ST APT 2R
BROOKLYN NY
11219-4995
US

V. Phone/Fax

Practice location:
  • Phone: 347-335-7688
  • Fax:
Mailing address:
  • Phone: 347-335-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3052271
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: