Provider Demographics
NPI:1144807397
Name:MAZZARELLI, LAUREL
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:MAZZARELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 DOANE RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-2305
Mailing Address - Country:US
Mailing Address - Phone:978-886-9478
Mailing Address - Fax:
Practice Address - Street 1:480 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1438
Practice Address - Country:US
Practice Address - Phone:774-205-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty