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General NPI Number Information
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NPI Number | 1205133329
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Entity Type | Individual
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Provider Name | NICOLE ELIZABETH MAYZNER LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 722 HANGAR RD
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City | KEESLER AFB
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State | MS
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Zip | 39534-2326
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Country | US
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Telephone | 228-377-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 701 FISHER ST
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City | BILOXI
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State | MS
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Zip | 39534-2506
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Country | US
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Telephone | 228-377-5361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005246
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License Number State | GA
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