Healthcare Provider Details

I. General information

NPI: 1316390875
Provider Name (Legal Business Name): MELISSA C MAZZIO ATR-BC,LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax: 914-788-4389
Mailing address:
  • Phone: 914-737-4400
  • Fax: 914-788-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: