Provider Demographics
NPI:1497378707
Name:MAZUR, CHERISE ANN (LSW)
Entity Type:Individual
Prefix:
First Name:CHERISE
Middle Name:ANN
Last Name:MAZUR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 LIBERTY AVE APT 905
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-3532
Mailing Address - Country:US
Mailing Address - Phone:814-823-7222
Mailing Address - Fax:
Practice Address - Street 1:700 5TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-3017
Practice Address - Country:US
Practice Address - Phone:412-697-0880
Practice Address - Fax:412-697-1234
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1235127754Medicaid