Provider Demographics
NPI:1629526660
Name:MAZUR, DEBORAH (EDS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MAZUR
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 BRONSON ST
Mailing Address - Street 2:
Mailing Address - City:PENINSULA
Mailing Address - State:OH
Mailing Address - Zip Code:44264-9644
Mailing Address - Country:US
Mailing Address - Phone:330-239-1901
Mailing Address - Fax:
Practice Address - Street 1:3940 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8618
Practice Address - Country:US
Practice Address - Phone:330-239-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool