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General NPI Number Information
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NPI Number | 1841443447
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Entity Type | Organization
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Legal Business Name | ELENA MAZZA, LCSW, LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 268 BROAD ST
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City | RED BANK
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State | NJ
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Zip | 07701-2042
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Country | US
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Telephone | 732-663-1344
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | RED BANK
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State | NJ
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Zip | 07701-0129
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Country | US
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Telephone | 732-663-1344
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. ELENA MAZZA
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Credential | MSW
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Telephone | 732-663-1344
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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 | 44SC04785100
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License Number State | NJ
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