BRADLEY S MAZICK (NPI# 1518933779) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518933779 |
| Entity Type | Individual |
| Full Name | BRADLEY S MAZICK |
| Credential | PHD,HSPP |
| Practice Address |
1920 Ridgedale Rd South Bend IN 46614-2243 |
| Practice Telephone | 5742318000 |
| Practice Fax Number | 5742318013 |
| Mailing Telephone | 5742318000 |
| Mailing Fax Number | 5742318013 |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2014-07-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
20041080 | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200200720A | 05 |
| Street Address |
1920 RIDGEDALE RD |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46614-2243 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447704945 | Jessica Longenecker | Counselor | 1920 Ridgedale Rd, South Bend, IN 46614-2243 | 2016-08-12 |
| 1487068441 | Kelly Howard | Counselor | 1920 Ridgedale Rd, South Bend, IN 46614-2243 | 2014-06-18 |
| 1659555852 | Behavior Services & Therapy | Community/Behavioral Health | 1920 Ridgedale Rd, South Bend, IN 46614-2243 | 2007-12-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417574013 | Hellen Gathesha | Nurse Practitioner | 2123 W Irvington Dr, South Bend, IN 46614 | 2020-06-30 |
| 1033759394 | Diane Galvas | Pharmacist | 1217 E. Ireland Rd., South Bend, IN 46614 | 2020-01-14 |
| 1730668690 | Julenne Henriquez-gil | Physical Therapist | 202 W Ireland Rd Ste 101a, South Bend, IN 46614 | 2018-08-11 |
| 1467747014 | Deidre A Coffey | Nurse Practitioner | 1025 Widener Ln, South Bend, IN 46614 | 2011-06-12 |
| 1588727655 | Wal-mart Stores East, Lp | Technician/Technologist | 700 W. Ireland Rd., South Bend, IN 46614 | 2006-12-19 |
| 1437262847 | Lori F Risser | Dentist | 734 E Ireland Rd, South Bend, IN 46614 | 2006-08-17 |
| 1912388018 | Laura Ellen Albright | Family Medicine | 2102 E Inwood Rd, South Bend, IN 46614 | 2015-06-15 |
| 1245626225 | Kathleen Kelley | Dermatology | 1815 E Ireland Rd, South Bend, IN 46614 | 2015-04-07 |
| 1073869806 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 1950 Ridgedale Rd, South Bend, IN 46614 | 2012-07-30 |
| 1326300666 | Kristine Marie Jones | Optometrist | 700 W Ireland Rd, South Bend, IN 46614 | 2012-06-12 |
| Find all providers in zip 46614 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346697000 | Alexandra Filia Corning | Psychologist | 1251 N. Eddy Street, Suite 200, South Bend, IN 46530-6258 | 2016-05-23 |
| 1629222088 | Suzanne Courtney | Psychologist | 129 Franklin Pl, South Bend, IN 46601-1543 | 2008-11-12 |
| 1518111996 | Jacqueline Mary Quinn-tan | Psychologist | 1000 S Michigan St, South Bend, IN 46601-3426 | 2008-11-11 |
| 1942487483 | David A Smith | Psychologist | 1251 N Eddy St Ste 200, South Bend, IN 46617-1478 | 2008-01-28 |
| 1972727949 | Susan Steibe-pasalich | Psychologist | 201 N Ironwood Dr, South Bend, IN 46615-2517 | 2007-04-12 |
| 1952452534 | Diane Johnson Prosser | Psychologist | 227 N Dixie Way Ste 110, South Bend, IN 46637-3366 | 2007-01-12 |
| 1053476697 | Barbara S Searle | Psychologist | 3603 E Jefferson Blvd, Suiteb, South Bend, IN 46615-3035 | 2006-12-26 |
| 1629144043 | Michael Owen Reed | Psychologist | 220 W Colfax Ave, Ste 400, South Bend, IN 46601-1635 | 2006-11-28 |
| 1902984958 | James F Brogle | Psychologist | 828 E Colfax Ave, South Bend, IN 46617-2804 | 2006-11-01 |
| 1518055565 | Michael Robert Sheehan | Psychologist | 1230 Hillcrest Rd, South Bend, IN 46617-1169 | 2006-10-11 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46614 |
Please comment or provide details below to improve the information on BRADLEY S MAZICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.