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General NPI Number Information
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NPI Number | 1982977385
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Entity Type | Individual
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Provider Name | DANIEL MICHAEL MAZZEO LISW-S
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Gender | Male
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 14701 DETROIT AVE STE 775
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City | LAKEWOOD
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State | OH
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Zip | 44107-4120
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Country | US
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Telephone | 216-352-3353
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Fax |
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Provider Business Mailing Address
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Address Line | 1442 NORTHLAND AVENUE
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City | LAKEWOOD
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State | OH
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Zip | 44107
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Country | US
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Telephone | 216-226-4242
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I 0009298
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License Number State | OH
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