MEDICARE: MR. JEFFREY THOMAS MAZZONE MA, LPC, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701014292	VA

General Provider Information

NPI Number	:	1174112114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY THOMAS MAZZONE MA, LPC, MA

Provider Business Mailing Address
First Line	:	1380 CENTRAL PARK BLVD STE 204
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-4926
Country	:	US
Telephone Number	:	540-602-2545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 CENTRAL PARK BLVD STE 204
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-4926
Country	:	US
Telephone Number	:	540-602-2545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	12/10/2024

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