Provider Demographics
NPI:1750813135
Name:ADELSON, MAUZIE MIMOSE
Entity type:Individual
Prefix:
First Name:MAUZIE
Middle Name:MIMOSE
Last Name:ADELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 NW HOGAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8708
Mailing Address - Country:US
Mailing Address - Phone:754-207-8904
Mailing Address - Fax:
Practice Address - Street 1:4574 S.E. DIXIE HWY
Practice Address - Street 2:TREASURE COAST
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997
Practice Address - Country:US
Practice Address - Phone:754-207-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst