Provider Demographics
NPI:1578065561
Name:MAZUREK, CARA BIBEAULT (LISW-CP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:BIBEAULT
Last Name:MAZUREK
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 SEVEN FARMS DRIVE
Mailing Address - Street 2:SUITE F BOX 288
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492
Mailing Address - Country:US
Mailing Address - Phone:803-542-9159
Mailing Address - Fax:
Practice Address - Street 1:222 W COLEMAN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3591
Practice Address - Country:US
Practice Address - Phone:803-542-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
SC143241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker