Provider Demographics
NPI:1457500928
Name:MAZZOLLA, KIMBERLY LYNNE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:MAZZOLLA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351C JAYCEE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-3045
Mailing Address - Country:US
Mailing Address - Phone:717-657-2080
Mailing Address - Fax:
Practice Address - Street 1:5351C JAYCEE AVE STE 1
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3045
Practice Address - Country:US
Practice Address - Phone:717-657-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health