Provider Demographics
NPI:1225385149
Name:MAZZEO, A. MICHEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:A.
Middle Name:MICHEL
Last Name:MAZZEO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BAYMEADOW PT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1041
Mailing Address - Country:US
Mailing Address - Phone:912-704-2088
Mailing Address - Fax:
Practice Address - Street 1:102 BAYMEADOW PT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-1041
Practice Address - Country:US
Practice Address - Phone:912-704-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002951103T00000X
FLPY 5950103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist