Provider Demographics
NPI:1588989131
Name:MAZUROK, IRENE M (LCSW, CSAC)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:M
Last Name:MAZUROK
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-845 POOKELA ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5700
Mailing Address - Country:US
Mailing Address - Phone:808-236-2600
Mailing Address - Fax:808-236-2626
Practice Address - Street 1:45-845 POOKELA ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5700
Practice Address - Country:US
Practice Address - Phone:808-236-2600
Practice Address - Fax:808-236-2626
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3293104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker