Provider Demographics
NPI:1992145338
Name:MAZZIO, LISA ANNE (PSYD, LCP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:MAZZIO
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2020
Mailing Address - Country:US
Mailing Address - Phone:757-354-1422
Mailing Address - Fax:
Practice Address - Street 1:1600 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2020
Practice Address - Country:US
Practice Address - Phone:757-354-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical