Active NPI
Gina Marie Mazzola, LMFT
- Marriage & Family Therapist
- Southport, CT
National Provider Identifier
1841067451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 3167
- Practice address
- 2960 Post Rd
Southport, CT 06890-1268 - Phone
- (203) 307-3030
- NPI assigned
- Dec 5, 2023
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 3167 | CT | Primary |
Addresses
Primary practice location
2960 Post Rd
Southport, CT 06890-1268
Mailing address
2960 Post Rd FL 3
Southport, CT 06890-1268
Phone (203) 307-3030
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 |
|---|---|---|---|
| 3167 | CT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Connecticut Counseling LLC | Marriage & Family Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Marriage & Family Therapist
- Southport, CT
- NPI 1982076014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701734400000",
"number": "1841067451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2960 POST RD FL 3",
"city": "SOUTHPORT",
"state": "CT",
"postal_code": "068901268",
"telephone_number": "203-307-3030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2960 POST RD",
"city": "SOUTHPORT",
"state": "CT",
"postal_code": "068901268",
"telephone_number": "203-307-3030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZOLA",
"first_name": "GINA",
"middle_name": "MARIE",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-05",
"last_updated": "2023-12-05",
"certification_date": "2023-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CT",
"license": "3167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.