Individual
MISS AMANDA ROSE MAZZONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
58 RICHMOND BLVD UNIT 3B, RONKONKOMA, NY 11779-3405
(631) 885-2257
Mailing address
58 RICHMOND BLVD UNIT 3B, RONKONKOMA, NY 11779-3405
(631) 885-2257
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
72094788
NY
1041C0700X
Clinical Social Worker
Primary
088549
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02173802
—
NY
Enumeration date
05/15/2015
Last updated
12/12/2023
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