Provider Demographics
NPI:1770474033
Name:MAZZA, CAROLINE G (MSPT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:G
Last Name:MAZZA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6654
Mailing Address - Country:US
Mailing Address - Phone:203-912-9444
Mailing Address - Fax:
Practice Address - Street 1:175B RENNELL DR
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1401
Practice Address - Country:US
Practice Address - Phone:203-307-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006674208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation