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General NPI Number Information
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NPI Number | 1801167705
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Entity Type | Organization
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Legal Business Name | JUDITH MAZZA, PH.D., P.A.
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 8504 MEADOWLARK LN
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City | BETHESDA
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State | MD
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Zip | 20817-2921
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Country | US
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Telephone | 301-469-7200
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Fax | 301-469-7200
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Provider Business Mailing Address
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Address Line | 8504 MEADOWLARK LN
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City | BETHESDA
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State | MD
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Zip | 20817-2921
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Country | US
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Telephone | 301-469-7200
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Fax | 301-469-7200
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUDITH MAZZA
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Credential | PH.D.
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Telephone | 301-365-0922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0912
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License Number State | MD
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