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General NPI Number Information
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NPI Number | 1750400115
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Entity Type | Individual
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Provider Name | FRANK ANTHONY MAZZOLA MFT CEAP SAP
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12520 MAGNOLIA BLVD 308
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-2336
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Country | US
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Telephone | 818-760-1967
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Fax | 818-760-7685
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Provider Business Mailing Address
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Address Line | 12520 MAGNOLIA BLVD 308
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-2336
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Country | US
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Telephone | 818-760-1967
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Fax | 818-760-7685
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M-14803
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License Number State | CA
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