Provider Demographics
NPI:1750488524
Name:MAZZA, DEBORAH L (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
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 1:19 WHITEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1473
Mailing Address - Country:US
Mailing Address - Phone:203-268-6715
Mailing Address - Fax:203-772-3842
Practice Address - Street 1:357 WHITNEY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2364
Practice Address - Country:US
Practice Address - Phone:203-772-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002251041C0700X
CT000313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000225OtherLCSW
CT052298OtherVALUE OPTIONS
CT140000225CT02OtherANTHEM BLUE CROSS
CT000313OtherMFT