Provider Demographics
NPI:1437462090
Name:MAZZUCA, BRANDI J
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:J
Last Name:MAZZUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 E 112TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2504
Mailing Address - Country:US
Mailing Address - Phone:303-903-2635
Mailing Address - Fax:303-333-4097
Practice Address - Street 1:3646 E 112TH PL
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-2504
Practice Address - Country:US
Practice Address - Phone:303-903-2635
Practice Address - Fax:303-333-4097
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst