Provider Demographics
NPI:1861442162
Name:MAZ, KATHRYN R (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:R
Last Name:MAZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 CHARTER LANE
Mailing Address - Street 2:LIFE MANAGEMENT ASSOCIATES
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5896
Mailing Address - Country:US
Mailing Address - Phone:717-394-6688
Mailing Address - Fax:717-394-6804
Practice Address - Street 1:200 WILLOW VALLEY DRIVE
Practice Address - Street 2:LIFE MANAGEMENT ASSOCIATES
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5896
Practice Address - Country:US
Practice Address - Phone:717-394-6688
Practice Address - Fax:717-394-6804
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007353L103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA462875OtherVALUE OPTIONS
PA03137701OtherCAPITAL BLUE CROSS