Provider Demographics
NPI:1538319520
Name:MAZZA, MARISA T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:T
Last Name:MAZZA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 BROADWAY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2234
Mailing Address - Country:US
Mailing Address - Phone:415-202-3031
Mailing Address - Fax:
Practice Address - Street 1:1970 BROADWAY
Practice Address - Street 2:SUITE 700
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2234
Practice Address - Country:US
Practice Address - Phone:415-202-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist