Provider Demographics
NPI:1700984994
Name:MOZO, MARY L (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:MOZO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4166
Mailing Address - Country:US
Mailing Address - Phone:603-890-8674
Mailing Address - Fax:603-890-8671
Practice Address - Street 1:289 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2731
Practice Address - Country:US
Practice Address - Phone:603-890-8674
Practice Address - Fax:603-890-8671
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80002567Medicaid
NH80002567Medicaid