Healthcare Provider Details

I. General information

NPI: 1659397008
Provider Name (Legal Business Name): PATRICIA ANN MAZZOCCA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 WASHINGTON ST
POUGHKEEPSIE NY
12601-2388
US

IV. Provider business mailing address

PO BOX 1141
NEW PALTZ NY
12561-7141
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-3680
  • Fax: 845-486-3690
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP45106
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: