MEDICARE: DR. RAE MAZZEI PSY.D., BCB

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	101YM0800X	Mental Health Counselor	178009902	IL
2	103TC0700X	Clinical Psychologist	071009211	IL
3	103TC0700X	Clinical Psychologist	PSY-004990	AZ

General Provider Information

NPI Number	:	1316340847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAE MAZZEI PSY.D., BCB

Provider Business Mailing Address
First Line	:	3377 S PRICE RD STE 2104
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-3573
Country	:	US
Telephone Number	:	480-448-6755
Fax Number	:

Provider Business Practice Location Address
First Line	:	3377 S PRICE RD STE 2104
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-3573
Country	:	US
Telephone Number	:	480-448-6755
Fax Number	:

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	09/28/2021

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