Provider Demographics
NPI:1114230257
Name:VAZZANO, STEPHANIE MW (MS, LCMHC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MW
Last Name:VAZZANO
Suffix:
Gender:F
Credentials:MS, LCMHC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4000
Mailing Address - Country:US
Mailing Address - Phone:603-225-2985
Mailing Address - Fax:
Practice Address - Street 1:21 GREEN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4000
Practice Address - Country:US
Practice Address - Phone:603-225-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health