Provider Demographics
NPI:1194706804
Name:MAZZOLINI, MARY JO (MA LSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:MAZZOLINI
Suffix:
Gender:F
Credentials:MA LSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 24242
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-0242
Mailing Address - Country:US
Mailing Address - Phone:216-839-2273
Mailing Address - Fax:216-839-2273
Practice Address - Street 1:15256 TRISKETT RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3034
Practice Address - Country:US
Practice Address - Phone:216-839-2273
Practice Address - Fax:216-896-0735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHS0013800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker