Provider Demographics
NPI:1982395398
Name:MAZZA, CONNIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ELIZABETH
Last Name:MAZZA
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 1:1016 NEWBURGH CT
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6251
Mailing Address - Country:US
Mailing Address - Phone:615-618-2243
Mailing Address - Fax:
Practice Address - Street 1:1750 HALLS CREEK RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-3718
Practice Address - Country:US
Practice Address - Phone:615-618-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional