Healthcare Provider Details

I. General information

NPI: 1851540991
Provider Name (Legal Business Name): JOANN MAZZOCCHI-FLEITZ LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ROSE ST
POUGHQUAG NY
12570-5733
US

IV. Provider business mailing address

19 ROSE ST
POUGHQUAG NY
12570-5733
US

V. Phone/Fax

Practice location:
  • Phone: 845-227-6574
  • Fax: 845-227-7450
Mailing address:
  • Phone: 845-227-6574
  • Fax: 845-227-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number069872-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: