Provider Demographics
NPI:1396960274
Name:MAZZARELLA, LAURIE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MAZZARELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-3172
Mailing Address - Country:US
Mailing Address - Phone:860-456-3177
Mailing Address - Fax:860-465-9626
Practice Address - Street 1:200 W TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2112
Practice Address - Country:US
Practice Address - Phone:860-886-1508
Practice Address - Fax:860-889-4606
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT0050401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical