Provider Demographics
NPI:1750400115
Name:MAZZOLA, FRANK ANTHONY (MFT CEAP SAP)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:ANTHONY
Last Name:MAZZOLA
Suffix:
Gender:M
Credentials:MFT CEAP SAP
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Other - First Name:
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Mailing Address - Street 1:12520 MAGNOLIA BLVD
Mailing Address - Street 2:308
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2336
Mailing Address - Country:US
Mailing Address - Phone:818-760-1967
Mailing Address - Fax:818-760-7685
Practice Address - Street 1:12520 MAGNOLIA BLVD
Practice Address - Street 2:308
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2336
Practice Address - Country:US
Practice Address - Phone:818-760-1967
Practice Address - Fax:818-760-7685
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAM-14803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11586291OtherCAQH