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General NPI Number Information
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NPI Number | 1679120851
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Entity Type | Individual
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Provider Name | ALISSA MAZZENGA MA, LMHC, LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 1770 WEST BERTEAU AVENUE SUITE 302A
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City | CHICAGO
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State | IL
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Zip | 60613
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Country | US
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Telephone | 847-567-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 4610 N CLARK ST # 1160
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City | CHICAGO
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State | IL
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Zip | 60640-4620
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Country | US
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Telephone | 847-567-7888
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 60947049
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License Number State | WA
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