Provider Demographics
NPI:1962411728
Name:REZAC, MARY M (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:REZAC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARCEY
Other - Middle Name:
Other - Last Name:REZAC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:30844 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5566
Mailing Address - Country:US
Mailing Address - Phone:302-345-1919
Mailing Address - Fax:
Practice Address - Street 1:30844 RIDGE CT
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-5566
Practice Address - Country:US
Practice Address - Phone:302-438-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00006001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical