Provider Demographics
NPI:1770989907
Name:MAZZUCCO, ROBERT (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MAZZUCCO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9147
Mailing Address - Country:US
Mailing Address - Phone:973-951-6087
Mailing Address - Fax:
Practice Address - Street 1:1 BANK ST STE 207
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3430
Practice Address - Country:US
Practice Address - Phone:973-951-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00147100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health