Provider Demographics
NPI:1578215331
Name:MAZZA, MARCI LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARCI
Middle Name:LYNN
Last Name:MAZZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N MICHIGAN AVE STE 1008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5310
Mailing Address - Country:US
Mailing Address - Phone:708-529-7672
Mailing Address - Fax:
Practice Address - Street 1:307 N MICHIGAN AVE STE 1008
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5310
Practice Address - Country:US
Practice Address - Phone:708-529-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178007232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178007232OtherIDFPR