Provider Demographics
NPI:1841443447
Name:ELENA MAZZA, LCSW, LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:ELENA MAZZA, LCSW, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:732-663-1344
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-0129
Mailing Address - Country:US
Mailing Address - Phone:732-663-1344
Mailing Address - Fax:
Practice Address - Street 1:268 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2042
Practice Address - Country:US
Practice Address - Phone:732-663-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047851001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty