Provider Demographics
NPI:1447732433
Name:MROZINSKI, TYRA
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:
Last Name:MROZINSKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3905
Mailing Address - Country:US
Mailing Address - Phone:831-236-1213
Mailing Address - Fax:
Practice Address - Street 1:141 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3905
Practice Address - Country:US
Practice Address - Phone:831-236-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC21749104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker