Provider Demographics
NPI:1912735788
Name:MAZYCK, ASHTON MCGREGOR
Entity type:Individual
Prefix:MR
First Name:ASHTON
Middle Name:MCGREGOR
Last Name:MAZYCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6606
Mailing Address - Country:US
Mailing Address - Phone:561-318-4476
Mailing Address - Fax:
Practice Address - Street 1:132 COUNTRY CLUB BLVD APT 708
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1561
Practice Address - Country:US
Practice Address - Phone:774-242-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)