Michael J Mazucci-Mambala, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW16647 Issued in FL

Practice address

510 Vonderburg Dr
Suite 301
Brandon, FL 33511-6072

Phone

(813) 881-1000

NPI assigned

Jan 6, 2020

Last updated

Jan 6, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ibis Healthcare Inc

  dba Gracepoint

  • Community/Behavioral Health Agency
  • Tampa, FL
  • NPI 1346224011

  Single Specialty

  NPD
• Ibis Healthcare Inc

  dba Gracepoint

  • Federally Qualified Health Center (FQHC)
  • Tampa, FL
  • NPI 1922777218
  NPD
• Lightshare Behavioral Wellness and Recovery

  • Community/Behavioral Health Agency
  • Venice, FL
  • NPI 1710557830
  NPD (past)
• Lightshare Behavioral Wellness and Recovery

  • Community/Behavioral Health Agency
  • Sarasota, FL
  • NPI 1942566674
  NPD (past)
• Phoenix Programs of Florida, Inc.

  dba Phoenix Houses of Florida

  • Community/Behavioral Health Agency
  • Brandon, FL
  • NPI 1962542423
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578268800000",
    "number": "1013556158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 VONDERBURG DR",
            "address_2": "SUITE 301",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116072",
            "telephone_number": "813-881-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 VONDERBURG DR",
            "address_2": "SUITE 301",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116072",
            "telephone_number": "813-881-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUCCI-MAMBALA",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-06",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maxim Healthcare Services, Inc
• Tamiko May, LMT
• Mayk, Inc (Accessible Home Health Care of Tampa)
• Miguel Angel Mazariegos, MD
• Mazen Kattih,MD, PA.
• MC Medical LLC (Walmart Health 2387)
• McAuley Dental
• Sarah Renee McAuley, DMD
• Kayla McBeath
• Diane McCarthy

• Clinical Social Worker in Brandon, FL
• Providers in Brandon, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.