Basic Information
| Provider Information | |||||||||
| NPI: | 1518142892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZZA | ||||||||
| FirstName: | SHAUNNA | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 STANLEY AVE | ||||||||
| Address2: | |||||||||
| City: | BERKLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027791917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084806328 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 TAUNTON GRN STE 5 | ||||||||
| Address2: | |||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027803243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088806666 | ||||||||
| FaxNumber: | 5088806656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2008 | ||||||||
| LastUpdateDate: | 06/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 7611 | MA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.