Provider Demographics
NPI:1548010515
Name:MAZUR, JOHN M (CASAC-T,CRPA,NYCPS-P)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MAZUR
Suffix:
Gender:M
Credentials:CASAC-T,CRPA,NYCPS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 FISH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CONSTABLEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13325-1816
Mailing Address - Country:US
Mailing Address - Phone:315-832-8418
Mailing Address - Fax:
Practice Address - Street 1:1213 COURT ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3803
Practice Address - Country:US
Practice Address - Phone:315-624-9835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P-5843175T00000X
NYVSR-5013175T00000X
NYCRPA-5954175T00000X
NY38948101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist