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General NPI Number Information
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NPI Number | 1477631307
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Entity Type | Organization
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Legal Business Name | MAZZONI CENTER
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 1348 BAINBRIDGE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1810
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Country | US
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Telephone | 215-563-0652
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Fax | 215-563-0664
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Provider Business Mailing Address
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Address Line | 1348 BAINBRIDGE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1810
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Country | US
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Telephone | 215-563-0652
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Fax | 215-563-0664
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Authorized Official
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Title or Position | COO
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Name | ALECIA MANLEY
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Credential |
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Telephone | 215-563-0652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 807382
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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