Provider Demographics
NPI:1063653418
Name:GONICK, LAURA IRENE MAZZA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:IRENE MAZZA
Last Name:GONICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OLD BAY RD
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9709
Mailing Address - Country:US
Mailing Address - Phone:413-530-4174
Mailing Address - Fax:
Practice Address - Street 1:16 OLD BAY RD
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9709
Practice Address - Country:US
Practice Address - Phone:413-530-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health