Provider Demographics
NPI:1487130787
Name:DELICES, MARIE BRIZARD (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:BRIZARD
Last Name:DELICES
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 BRETHREN DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5640
Mailing Address - Country:US
Mailing Address - Phone:347-463-6704
Mailing Address - Fax:
Practice Address - Street 1:7905 BRETHREN DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5640
Practice Address - Country:US
Practice Address - Phone:347-463-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty