MEDICARE: MR. LEWIS A MAZZONE JR. MA, SSP, BCBA, NCSP

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	103K00000X	Behavior Analyst
2	103TS0200X	School Psychologist	SS1897	FL

General Provider Information

NPI Number	:	1841066743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEWIS A MAZZONE JR. MA, SSP, BCBA, NCSP

Provider Business Mailing Address
First Line	:	4823 ROLLING GREEN DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7044
Country	:	US
Telephone Number	:	516-395-7543
Fax Number	:

Provider Business Practice Location Address
First Line	:	4823 ROLLING GREEN DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7044
Country	:	US
Telephone Number	:	516-395-7543
Fax Number	:

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

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	01/21/2026

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