Provider Demographics
NPI:1306616651
Name:ALISSA MAZZENGA PLLC
Entity type:Organization
Organization Name:ALISSA MAZZENGA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-567-7888
Mailing Address - Street 1:4610 N CLARK ST # 1160
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4620
Mailing Address - Country:US
Mailing Address - Phone:847-567-7888
Mailing Address - Fax:
Practice Address - Street 1:1770 W BERTEAU AVE STE 302A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1750
Practice Address - Country:US
Practice Address - Phone:847-567-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty