Provider Demographics
NPI:1982708616
Name:MAZZELLA, ANTHONY (MSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MAZZELLA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WHARTON DR
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7430
Mailing Address - Country:US
Mailing Address - Phone:914-260-4166
Mailing Address - Fax:914-402-7470
Practice Address - Street 1:50 COLUMBIA AVE
Practice Address - Street 2:HARTSDALE SEVENTH-DAY ADVENTIST CHURCH
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2510
Practice Address - Country:US
Practice Address - Phone:914-260-4166
Practice Address - Fax:914-402-7470
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0495901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP432884OtherOXFORD
NY02218835Medicaid
NY1017440OtherBEACON HEALTH STRATEGIES
NY2100424OtherCIGNA
NY457491OtherVALUE OPTIONS
NY7479555OtherGHI
NYR049590OtherHIP
NY259357OtherMHN
NY2100424OtherCIGNA