Healthcare Provider Details

I. General information

NPI: 1336205830
Provider Name (Legal Business Name): VICTORIA MAZUR-KAZAN LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 BROADWAY
NEWBURGH NY
12550
US

IV. Provider business mailing address

141 BROADWAY
NEWBURGH NY
12550
US

V. Phone/Fax

Practice location:
  • Phone: 845-568-5260
  • Fax: 845-568-5213
Mailing address:
  • Phone: 845-568-5260
  • Fax: 845-568-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number033383
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: