Provider Demographics
NPI:1316344161
Name:MAZZARINO, JOHN (CASAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MAZZARINO
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1701
Mailing Address - Country:US
Mailing Address - Phone:212-736-5900
Mailing Address - Fax:212-643-1441
Practice Address - Street 1:311 W 35TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1701
Practice Address - Country:US
Practice Address - Phone:212-736-5900
Practice Address - Fax:212-643-1441
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25565101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)