Provider Demographics
NPI:1558795567
Name:MAZZARELLA, GINA (LMHC, NCC, TTS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MAZZARELLA
Suffix:
Gender:F
Credentials:LMHC, NCC, TTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-2101
Mailing Address - Country:US
Mailing Address - Phone:407-323-2036
Mailing Address - Fax:
Practice Address - Street 1:919 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2101
Practice Address - Country:US
Practice Address - Phone:407-323-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9865101YM0800X
299022101YM0800X
FLMH12374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health