Healthcare Provider Details

I. General information

NPI: 1962129122
Provider Name (Legal Business Name): JOSEPH SAMUEL MAZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BRISTOL CT
WYOMISSING PA
19610-1805
US

IV. Provider business mailing address

3801 SW 13TH ST APT C219
GAINESVILLE FL
32608-3546
US

V. Phone/Fax

Practice location:
  • Phone: 610-320-4429
  • Fax:
Mailing address:
  • Phone: 484-649-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-240193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: