Healthcare Provider Details

I. General information

NPI: 1861442162
Provider Name (Legal Business Name): KATHRYN R MAZ PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WILLOW VALLEY DRIVE LIFE MANAGEMENT ASSOCIATES
LANCASTER PA
17601-5896
US

IV. Provider business mailing address

1848 CHARTER LANE LIFE MANAGEMENT ASSOCIATES
LANCASTER PA
17601-5896
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-6688
  • Fax: 717-394-6804
Mailing address:
  • Phone: 717-394-6688
  • Fax: 717-394-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007353L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPS007353L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: