Provider Demographics
NPI:1851577472
Name:MAZELLAN, JOHN W (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MAZELLAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 AMWELL RD
Mailing Address - Street 2:BLDG 4 / SUITE 401
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1225
Mailing Address - Country:US
Mailing Address - Phone:908-431-9200
Mailing Address - Fax:908-431-9205
Practice Address - Street 1:390 AMWELL RD
Practice Address - Street 2:BLDG 4 / SUITE 401
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1225
Practice Address - Country:US
Practice Address - Phone:908-431-9200
Practice Address - Fax:908-431-9205
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006066001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical