Provider Demographics
NPI:1972660421
Name:MANCINI-MEZZACAPPA, GIULIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GIULIA
Middle Name:
Last Name:MANCINI-MEZZACAPPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:GIULIA
Other - Middle Name:
Other - Last Name:MEZZACAPPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:55 LAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655-0002
Mailing Address - Country:US
Mailing Address - Phone:508-856-6578
Mailing Address - Fax:508-856-5990
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-856-6578
Practice Address - Fax:508-856-5990
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1566362084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3193942Medicaid
MA15820119OtherCIGNA
MAA29484Medicare ID - Type Unspecified