Mazick, Bradley S
Mazick, Bradley S is an individual health care provider with primary practice located at 1920 Ridgedale Rd , South Bend IN 46614-2243. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Mazick, Bradley S can be contacted via phone (574) 231-8000.Contact Information
Primary practice address
1920 Ridgedale Rd
South Bend IN 46614-2243
Phone: (574) 231-8000
Fax: (574) 231-8013
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 20041080 | Indiana |
Profile Details
| NPI number | 1518933779 |
|---|---|
| LBN Legal business name | Mazick, Bradley S |
| Credentials | PHD,HSPP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 27th, 2006 |
| Last updated | Jul 22nd, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518933779 | NPPES |
| Indiana | MEDICAID | 200200720A |
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