Provider Demographics
NPI:1043800162
Name:JENNIE MAZZA JONES LCSW PLLC
Entity Type:Organization
Organization Name:JENNIE MAZZA JONES LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZA JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:315-737-3094
Mailing Address - Street 1:2 WILLIAMS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1748
Mailing Address - Country:US
Mailing Address - Phone:315-737-3094
Mailing Address - Fax:
Practice Address - Street 1:2 WILLIAMS ST STE 2
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1748
Practice Address - Country:US
Practice Address - Phone:315-737-3094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty