Provider Demographics
NPI:1205533361
Name:ZAZZARO, ATHENA (LMHC)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:ZAZZARO
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 1:93 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4640
Mailing Address - Country:US
Mailing Address - Phone:860-984-3474
Mailing Address - Fax:
Practice Address - Street 1:152 SYLVAN ST FL 2A
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3581
Practice Address - Country:US
Practice Address - Phone:978-222-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC13567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1205533361Medicaid
NONEOtherNONE