Provider Demographics
NPI:1225676828
Name:MAZZOLA, MADELEINE LAUREN (LMFT 94033)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:LAUREN
Last Name:MAZZOLA
Suffix:
Gender:F
Credentials:LMFT 94033
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:LAUREN
Other - Last Name:MANDICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT 94033
Mailing Address - Street 1:1500 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4523
Mailing Address - Country:US
Mailing Address - Phone:415-474-7310
Mailing Address - Fax:
Practice Address - Street 1:1500 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4523
Practice Address - Country:US
Practice Address - Phone:415-474-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist