Provider Demographics
NPI:1073645867
Name:MAZDA, MARY PAT (RN MSS LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY PAT
Middle Name:
Last Name:MAZDA
Suffix:
Gender:F
Credentials:RN MSS LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1206 JOSHUA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380
Mailing Address - Country:US
Mailing Address - Phone:610-344-7750
Mailing Address - Fax:610-964-8887
Practice Address - Street 1:987 OLD EAGLE SCHOOL RD
Practice Address - Street 2:SUITE #712 BLDG K
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:610-344-7750
Practice Address - Fax:610-964-8887
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW009071L1041C0700X
PARN290507L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse