Healthcare Provider Details

I. General information

NPI: 1386997708
Provider Name (Legal Business Name): MARY PIZZICA LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MARY RIFE

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 05/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ARLINGTON AVE
BALTIMORE MD
21223-2671
US

IV. Provider business mailing address

3200 EASTERN AVE
BALTIMORE MD
21224-4010
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-7180
  • Fax:
Mailing address:
  • Phone: 410-522-1181
  • Fax: 410-522-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13794
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: