MEDICARE: KAREN MOZZER LICSW

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	1041C0700X	Clinical Social Worker	1022487	MA
2	1041C0700X	Clinical Social Worker	005054	CT

General Provider Information

NPI Number	:	1982642310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MOZZER LICSW

Provider Business Mailing Address
First Line	:	20 GRAND BLVD
Second Line	:
City	:	ELLINGTON
State	:	CT
Zip	:	06029-3895
Country	:	US
Telephone Number	:	860-896-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 WESTFIELD ST
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-3878
Country	:	US
Telephone Number	:	413-592-1980
Fax Number	:	413-439-0096

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	02/06/2008

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