Healthcare Provider Details

I. General information

NPI: 1962411728
Provider Name (Legal Business Name): MARY M. REZAC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCEY REZAC LCSW

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30844 RIDGE CT
LEWES DE
19958-5566
US

IV. Provider business mailing address

30844 RIDGE CT
LEWES DE
19958-5566
US

V. Phone/Fax

Practice location:
  • Phone: 302-438-8733
  • Fax:
Mailing address:
  • Phone: 302-345-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000600
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: