Provider Demographics
NPI:1538656889
Name:MAZZA, RACHAEL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MAZZA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MULBERRY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1233
Mailing Address - Country:US
Mailing Address - Phone:570-955-5479
Mailing Address - Fax:570-955-5528
Practice Address - Street 1:300 MULBERRY ST STE 201
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1233
Practice Address - Country:US
Practice Address - Phone:570-955-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-21
Last Update Date:2018-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010397101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor