Provider Demographics
NPI:1851540991
Name:MAZZOCCHI-FLEITZ, JOANN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:MAZZOCCHI-FLEITZ
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5733
Mailing Address - Country:US
Mailing Address - Phone:845-227-6574
Mailing Address - Fax:845-227-7450
Practice Address - Street 1:19 ROSE ST
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5733
Practice Address - Country:US
Practice Address - Phone:845-227-6574
Practice Address - Fax:845-227-7450
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069872-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker