Provider Demographics
NPI:1689299190
Name:MAZZONE, KERRI (LISW-S)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:MAZZONE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2808
Mailing Address - Country:US
Mailing Address - Phone:440-665-9289
Mailing Address - Fax:
Practice Address - Street 1:6133 ROCKSIDE RD STE 403
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2244
Practice Address - Country:US
Practice Address - Phone:216-455-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1000022-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical