| Doctor Name: | KRISTIN NICOLE MAZZARESE |
| NPI Number: | 1407128473 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | LC3866 |
| Business Practice Address: | 11350 Mccormick Rd Executive Plaza I, Suite 408 Hunt Valley, MD - 210311002 |
| Business Phone Number: | 4105270280 |
| Business Fax Number: | |
| Mailing Address: | 23 Brampton Ct, REISTERSTOWN |
| State: | MD |
| Postal Code: | 211366431 |
| Phone Number: | 4432042017 |
| Fax Number: | |
| NPI Enumeration Date: | 02/06/2012 |
| NPI Last Update Date: | 02/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LC3866 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |