Provider Demographics
NPI:1730067257
Name:MAZZOTTI, GINO G
Entity type:Individual
Prefix:
First Name:GINO
Middle Name:G
Last Name:MAZZOTTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 14TH AVE E APT 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4567
Mailing Address - Country:US
Mailing Address - Phone:206-818-2256
Mailing Address - Fax:
Practice Address - Street 1:1728 E MADISON ST OFC 6
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2733
Practice Address - Country:US
Practice Address - Phone:206-818-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health