Provider Demographics
NPI:1841066743
Name:MAZZONE, LEWIS A JR (MA, SSP, BCBA, NCSP)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:A
Last Name:MAZZONE
Suffix:JR
Gender:M
Credentials:MA, SSP, BCBA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 ROLLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7044
Mailing Address - Country:US
Mailing Address - Phone:516-395-7543
Mailing Address - Fax:
Practice Address - Street 1:4823 ROLLING GREEN DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-7044
Practice Address - Country:US
Practice Address - Phone:516-395-7543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst