Provider Demographics
NPI:1538649785
Name:MAZZONE, COURTNEY KENNEALLY (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KENNEALLY
Last Name:MAZZONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:KLIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:435 NEW KARNER RD STE 17
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5841
Mailing Address - Country:US
Mailing Address - Phone:518-456-2060
Mailing Address - Fax:518-456-2361
Practice Address - Street 1:435 NEW KARNER RD STE 17
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5841
Practice Address - Country:US
Practice Address - Phone:518-456-2060
Practice Address - Fax:518-456-2361
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087010-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical