Provider Demographics
NPI:1497744031
Name:MAZURE, CAROLYN M (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:MAZURE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 COLLEGE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2483
Mailing Address - Country:US
Mailing Address - Phone:203-688-9711
Mailing Address - Fax:203-688-9709
Practice Address - Street 1:135 COLLEGE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2483
Practice Address - Country:US
Practice Address - Phone:203-688-9711
Practice Address - Fax:203-688-9709
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004174231Medicaid
CT680000433Medicare ID - Type Unspecified