Provider Demographics
NPI:1174112114
Name:MAZZONE, JEFFREY THOMAS (MA, LPC, MA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:MAZZONE
Suffix:
Gender:M
Credentials:MA, LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 CENTRAL PARK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4926
Mailing Address - Country:US
Mailing Address - Phone:540-602-2545
Mailing Address - Fax:
Practice Address - Street 1:1380 CENTRAL PARK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4926
Practice Address - Country:US
Practice Address - Phone:540-602-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional