Provider Demographics
NPI:1003049891
Name:MAZZARISI, AMY (LMHC)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:
Last Name:MAZZARISI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1502
Mailing Address - Country:US
Mailing Address - Phone:917-838-9466
Mailing Address - Fax:
Practice Address - Street 1:14 SLOSSON TER
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2507
Practice Address - Country:US
Practice Address - Phone:718-273-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY008566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003049891Medicaid