Individual
BRADLEY S MAZICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD,HSPP
Contact information
Practice address
1920 RIDGEDALE RD, SOUTH BEND, IN 46614-2243
(574) 231-8000
(574) 231-8013
Mailing address
1920 RIDGEDALE RD, SOUTH BEND, IN 46614-2243
(574) 231-8000
(574) 231-8013
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041080
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200200720A
—
IN
Enumeration date
02/27/2006
Last updated
07/22/2014
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