Healthcare Provider Details

I. General information

NPI: 1366225120
Provider Name (Legal Business Name): MOLLY SUZANNE MAZAL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S ALLEN ST STE 421
STATE COLLEGE PA
16801-4852
US

IV. Provider business mailing address

315 S ALLEN ST STE 421
STATE COLLEGE PA
16801-4852
US

V. Phone/Fax

Practice location:
  • Phone: 814-264-2584
  • Fax:
Mailing address:
  • Phone: 814-264-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS019964
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number9821716
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: