Provider Demographics
NPI:1194932251
Name:MARTONE MAZZA, GWEN ELLEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:GWEN
Middle Name:ELLEN
Last Name:MARTONE MAZZA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 KIRKGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2124
Mailing Address - Country:US
Mailing Address - Phone:585-349-2280
Mailing Address - Fax:585-723-5544
Practice Address - Street 1:2024 W HENRIETTA RD
Practice Address - Street 2:SUITE 3-F
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1355
Practice Address - Country:US
Practice Address - Phone:585-713-5544
Practice Address - Fax:585-723-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001115-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health