Provider Demographics
NPI:1316587900
Name:MAZICH, LEANNA J (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LEANNA
Middle Name:J
Last Name:MAZICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10417 S HORTON RD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9509
Mailing Address - Country:US
Mailing Address - Phone:248-933-4806
Mailing Address - Fax:
Practice Address - Street 1:10417 S HORTON RD
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438-9509
Practice Address - Country:US
Practice Address - Phone:248-933-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010972161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical