Provider Demographics
NPI:1356856058
Name:MAZURKIEWICZ, CHRISTINE DOLORES (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DOLORES
Last Name:MAZURKIEWICZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 BATES RD
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-9549
Mailing Address - Country:US
Mailing Address - Phone:570-617-0204
Mailing Address - Fax:
Practice Address - Street 1:7045 BATES RD
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-9549
Practice Address - Country:US
Practice Address - Phone:717-454-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist