Provider Demographics
NPI:1346579505
Name:MAZZARELLA, BERNADETTE MARTHA (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MARTHA
Last Name:MAZZARELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BERNADETTE
Other - Middle Name:MARTHA
Other - Last Name:ZALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1041 W. BRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-933-8110
Mailing Address - Fax:
Practice Address - Street 1:14 HOAG LN
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-3701
Practice Address - Country:US
Practice Address - Phone:610-368-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0158731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical