Doctor Name: | STEPHANIE MAZZANTI |
NPI Number: | 1154715597 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 180.009102 |
Business Practice Address: | 33601 N Royal Oak Ln Apt 105 Grayslake, IL - 600302807 |
Business Phone Number: | 3126080097 |
Business Fax Number: | |
Mailing Address: | 3633 W Lake Ave Ste 404, GLENVIEW |
State: | IL |
Postal Code: | 600265801 |
Phone Number: | 3126080097 |
Fax Number: | |
NPI Enumeration Date: | 03/24/2015 |
NPI Last Update Date: | 03/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 180.009102 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |