Individual
MARY PAT MAZZOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST-MA
Contact information
Practice address
185 NORTH ST, BENNINGTON, VT 05201-1813
(802) 688-6262
Mailing address
120 MONUMENT AVE, BENNINGTON, VT 05201-2133
(802) 688-6262
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
047-0000645
VT
103TA0700X
Adult Development & Aging Psychologist
047-0000645
VT
103TB0200X
Cognitive & Behavioral Psychologist
047-0000645
VT
103TC1900X
Counseling Psychologist
Primary
047-0000645
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007784
—
VT
01
—
2070654
CIGNA
VT
01
—
360032
MANAGED HEALTH NET
VT
01
—
59034
BLUE CROSS
VT
Enumeration date
08/05/2006
Last updated
06/13/2014
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