Provider Demographics
NPI:1659114270
Name:MAZUROVSKY, YEVGENIYA
Entity type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:MAZUROVSKY
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 1:9217 OLMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-3603
Mailing Address - Country:US
Mailing Address - Phone:917-685-8084
Mailing Address - Fax:
Practice Address - Street 1:9217 OLMSTEAD DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-3603
Practice Address - Country:US
Practice Address - Phone:917-685-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078847-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker