Provider Demographics
NPI:1407372519
Name:MAZROLLE, SUSAN ANN (MSRD, LDN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:MAZROLLE
Suffix:
Gender:F
Credentials:MSRD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WINSOR ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3491
Mailing Address - Country:US
Mailing Address - Phone:413-531-3490
Mailing Address - Fax:
Practice Address - Street 1:27 WINSOR ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3491
Practice Address - Country:US
Practice Address - Phone:413-531-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1316133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered