Provider Demographics
NPI:1619776598
Name:MAZZA, ISABELLA (LMHC, R-DMT)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:MAZZA
Suffix:
Gender:
Credentials:LMHC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431A BROADWAY APT 24
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2322
Mailing Address - Country:US
Mailing Address - Phone:631-804-7742
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE STE 808
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1984
Practice Address - Country:US
Practice Address - Phone:774-614-9899
Practice Address - Fax:508-919-8187
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2608225600000X
MALMHC5000781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist