Provider Demographics
NPI:1669514170
Name:MIZNER, HAROLD JERRY (HAROLD MIZNER)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:JERRY
Last Name:MIZNER
Suffix:
Gender:M
Credentials:HAROLD MIZNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3723
Mailing Address - Country:US
Mailing Address - Phone:508-336-3717
Mailing Address - Fax:
Practice Address - Street 1:135 NEW MEADOW RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3347
Practice Address - Country:US
Practice Address - Phone:508-379-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional