Provider Demographics
NPI:1396190161
Name:MAZER, ANGELA BLANK (LCPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BLANK
Last Name:MAZER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROSSROADS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5480
Mailing Address - Country:US
Mailing Address - Phone:410-356-2007
Mailing Address - Fax:410-356-2077
Practice Address - Street 1:20 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5419
Practice Address - Country:US
Practice Address - Phone:410-356-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5593101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional