Provider Demographics
NPI:1679517890
Name:MAZZA, ELENA THERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:THERESA
Last Name:MAZZA
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-0129
Mailing Address - Country:US
Mailing Address - Phone:732-663-1344
Mailing Address - Fax:
Practice Address - Street 1:268 BROAD STREET
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2042
Practice Address - Country:US
Practice Address - Phone:732-663-1344
Practice Address - Fax:732-663-1334
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047851001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2458807OtherOXFORD HEALTH PLANS
NJ27135400OtherMAGELLAN
NJ0019810Medicaid
NJ0019810Medicaid