MEDICARE: JILLIAN MICHELLE MAZZA LMHC

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	MH27792	FL

General Provider Information

NPI Number	:	1861324410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN MICHELLE MAZZA LMHC

Provider Business Mailing Address
First Line	:	12302 SANNENWOOD LN
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4981
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 S STATE ROAD 7 STE 108
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4304
Country	:	US
Telephone Number	:	561-281-1576
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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