Provider Demographics
NPI:1578907697
Name:MAZZOCCA, TINA MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIA
Last Name:MAZZOCCA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 B LIPPINCOTT DR.
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-512-8108
Mailing Address - Fax:877-825-9890
Practice Address - Street 1:562 LIPPINCOTT DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4810
Practice Address - Country:US
Practice Address - Phone:856-512-8108
Practice Address - Fax:877-825-9890
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05514100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health