Provider Demographics
NPI:1265118707
Name:MAZENKAS, BRIDGET (LICSSW)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MAZENKAS
Suffix:
Gender:F
Credentials:LICSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-2007
Mailing Address - Country:US
Mailing Address - Phone:781-626-1284
Mailing Address - Fax:
Practice Address - Street 1:555 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-2007
Practice Address - Country:US
Practice Address - Phone:781-626-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1266591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical