Provider Demographics
NPI:1205030970
Name:MAZZOTTA, LAURA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAZZOTTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 ROUTE 52
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-4549
Mailing Address - Country:US
Mailing Address - Phone:914-420-2898
Mailing Address - Fax:845-704-0478
Practice Address - Street 1:1110 ROUTE 52
Practice Address - Street 2:SUITE 216
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4549
Practice Address - Country:US
Practice Address - Phone:914-420-2898
Practice Address - Fax:845-704-0478
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0790231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical