Provider Demographics
NPI:1487636528
Name:MAZUR, HENRY A (LISW CCDC IIIE)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:A
Last Name:MAZUR
Suffix:
Gender:M
Credentials:LISW CCDC IIIE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24242
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-0242
Mailing Address - Country:US
Mailing Address - Phone:216-839-2273
Mailing Address - Fax:216-896-0735
Practice Address - Street 1:28790 CHAGRIN BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44122-4642
Practice Address - Country:US
Practice Address - Phone:216-839-2273
Practice Address - Fax:216-896-0735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0004140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMASW12091Medicare ID - Type Unspecified