Provider Demographics
NPI:1891317277
Name:MAZZA, CHRISTIAN DAVID (MT-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DAVID
Last Name:MAZZA
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BRIGHTON CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5659
Mailing Address - Country:US
Mailing Address - Phone:304-677-0402
Mailing Address - Fax:
Practice Address - Street 1:2031 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2401
Practice Address - Country:US
Practice Address - Phone:330-740-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty