Active NPI
Kristan Mazaka, LICSW
- Clinical Social Worker
- Methuen, MA
National Provider Identifier
1376094888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 118619
- Practice address
- 19 1/2 Mystic Street
Methuen, MA 01844 - Phone
- (978) 794-8668
- NPI assigned
- Oct 19, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 118619 | MA | Primary |
Addresses
Primary practice location
19 1/2 Mystic Street
Methuen, MA 01844
Mailing address
47 Manter Mill Rd
Londonderry, NH 03053-2394
Phone (978) 604-1294
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118619 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1376094888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47 MANTER MILL RD",
"city": "LONDONDERRY",
"state": "NH",
"postal_code": "030532394",
"telephone_number": "978-604-1294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 1/2 MYSTIC STREET",
"city": "METHUEN",
"state": "MA",
"postal_code": "01844",
"telephone_number": "978-794-8668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZAKA",
"first_name": "KRISTAN",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-19",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "118619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Methuen, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.