Provider Demographics
NPI:1982937256
Name:MAZARIEGOS, MADELINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:
Last Name:MAZARIEGOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 COURT A
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-3353
Mailing Address - Country:US
Mailing Address - Phone:203-870-1122
Mailing Address - Fax:
Practice Address - Street 1:46 COURT A
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-3353
Practice Address - Country:US
Practice Address - Phone:203-870-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical