Provider Demographics
NPI:1801167705
Name:JUDITH MAZZA, PH.D., P.A.
Entity type:Organization
Organization Name:JUDITH MAZZA, PH.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-365-0922
Mailing Address - Street 1:8504 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2921
Mailing Address - Country:US
Mailing Address - Phone:301-469-7200
Mailing Address - Fax:301-469-7200
Practice Address - Street 1:8504 MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2921
Practice Address - Country:US
Practice Address - Phone:301-469-7200
Practice Address - Fax:301-469-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1073673075OtherNPI
MD0912OtherMARYLAND PSYCHOLOGIST LICENSE NUMBER
421785Medicare PIN