Provider Demographics
NPI:1093241549
Name:MAZZONE, MICHAEL (BCBA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MAZZONE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 N RANCHO DR STE 113
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3188
Mailing Address - Country:US
Mailing Address - Phone:702-209-3544
Mailing Address - Fax:725-205-3800
Practice Address - Street 1:3660 N RANCHO DR STE 113
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3188
Practice Address - Country:US
Practice Address - Phone:702-209-3544
Practice Address - Fax:725-205-3800
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1-16-24661103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst