MEDICARE: MS. MARY JO MAZZOLINI MA LSW

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	104100000X	Social Worker	S0013800	OH

General Provider Information

NPI Number	:	1194706804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JO MAZZOLINI MA LSW

Provider Business Mailing Address
First Line	:	PO BOX 24242
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-0242
Country	:	US
Telephone Number	:	216-839-2273
Fax Number	:	216-839-2273

Provider Business Practice Location Address
First Line	:	15256 TRISKETT RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3034
Country	:	US
Telephone Number	:	216-839-2273
Fax Number	:	216-896-0735

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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