Provider Demographics
NPI:1154413144
Name:MAZEROFF, PAUL (EDD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MAZEROFF
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W. ELM AVENUE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-632-4900
Mailing Address - Fax:717-632-4313
Practice Address - Street 1:625 W. ELM AVENUE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-632-4900
Practice Address - Fax:717-632-4313
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008389L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007446410021Medicaid
PA099149FDBMedicare ID - Type Unspecified