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NPI Code Detail

MEDICARE: MAZZONI CENTER

MEDICARE: MAZZONI CENTER
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
1101YM0800XMental Health Counselor
2104100000XSocial Worker
3251B00000XCase Management Agency
4251S00000XCommunity/Behavioral Health Agency807382PA
5207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477631307
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAZZONI CENTER
Provider Business Mailing Address
First Line : 1348 BAINBRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-1810
Country : US
Telephone Number : 215-563-0652
Fax Number : 215-563-0664
Provider Business Practice Location Address
First Line : 1348 BAINBRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-1810
Country : US
Telephone Number : 215-563-0652
Fax Number : 215-563-0664
Authorized Official
Title or Position : COO
Name : ALECIA MANLEY
Credential :
Telephone Number : 215-563-0652
Provider Enumeration Date : 11/01/2006
Last Update Date : 09/05/2023

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1922503853 — RACHEL SPRINGER MD
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1215417472 — EMILY ELIZABETH SKONECKI PHARMD
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Practice Fax: 215-625-7906

Directions to “MAZZONI CENTER ” Practice Location

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