Provider Demographics
NPI:1770787111
Name:MAZZARELLA, WILLIAM HENRY JR (COUNSELOR)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:MAZZARELLA
Suffix:JR
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 COMMERCIAL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-1364
Mailing Address - Country:US
Mailing Address - Phone:619-380-0560
Mailing Address - Fax:
Practice Address - Street 1:2456 E ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2024
Practice Address - Country:US
Practice Address - Phone:619-503-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530630163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)