Provider Demographics
NPI:1093357527
Name:BOZAGLO, MAZAL MALI
Entity Type:Individual
Prefix:
First Name:MAZAL
Middle Name:MALI
Last Name:BOZAGLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2312
Mailing Address - Country:US
Mailing Address - Phone:718-981-8117
Mailing Address - Fax:
Practice Address - Street 1:1268 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2312
Practice Address - Country:US
Practice Address - Phone:718-981-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)