Provider Demographics
NPI:1497253389
Name:MAZZAFERRO, LAURA E (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:E
Last Name:MAZZAFERRO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:HARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 BARCLAY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3636
Mailing Address - Country:US
Mailing Address - Phone:516-637-5979
Mailing Address - Fax:
Practice Address - Street 1:115 BARCLAY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3636
Practice Address - Country:US
Practice Address - Phone:516-637-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health