Provider Demographics
NPI:1336302892
Name:MAZUR, ANGELA ROSE (MA,LLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ROSE
Last Name:MAZUR
Suffix:
Gender:F
Credentials:MA,LLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ROSE
Other - Last Name:FIORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2011 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4049
Mailing Address - Country:US
Mailing Address - Phone:248-414-4050
Mailing Address - Fax:248-414-4053
Practice Address - Street 1:39343 LEDGATE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2339
Practice Address - Country:US
Practice Address - Phone:586-939-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-04
Last Update Date:2008-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical