Provider Demographics
NPI:1255044111
Name:MAZUR, DANIELLE J
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:J
Last Name:MAZUR
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 1:1656 PERLICH ST
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4668
Mailing Address - Country:US
Mailing Address - Phone:703-609-4845
Mailing Address - Fax:
Practice Address - Street 1:1656 PERLICH ST
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4668
Practice Address - Country:US
Practice Address - Phone:703-609-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500806251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical