Provider Demographics
NPI:1467034892
Name:MZMA, LLC
Entity Type:Organization
Organization Name:MZMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYEROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:347-674-5516
Mailing Address - Street 1:2412 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5018
Mailing Address - Country:US
Mailing Address - Phone:917-627-4962
Mailing Address - Fax:
Practice Address - Street 1:247 PROSPECT AVE STE 4F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:347-674-5516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty