Provider Demographics
NPI:1043301500
Name:MAZZIOTTI, JANET S (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:MAZZIOTTI
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CENTER ST STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3411
Mailing Address - Country:US
Mailing Address - Phone:413-531-2144
Mailing Address - Fax:
Practice Address - Street 1:40 CENTER ST STE 6
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3411
Practice Address - Country:US
Practice Address - Phone:413-531-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300865Medicaid