Jessica Lauren Maza | Staten Island, NY • PECOS Search

Jessica Lauren Maza

Counselor

Behavioral Health & Social Service Providers

2291 Victory Blvd, Staten Island, NY 10314-6625

(718) 569-7314 (718) 813-9816

PECOS Enrollment

Based on the most recent information from CMS, provider Jessica Lauren Maza does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 1:08 PM.

Profile Details

Provider ID
1518420454
Provider Type
Individual
Full Name
Maza, Jessica Lauren
Title
Mrs.
Credential
MHC-LP

Gender
Female
Sole Proprietor
No
Enumeration Date
4/8/2019
Last Updated
4/8/2019

Contact Information

Practice Location

2291 Victory Blvd, Staten Island, NY 10314-6625

Unlisted Fax

Mailing Location

112 Kingsley Ave, Staten Island, NY 10314-2423

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer