Provider Demographics
NPI:1386997708
Name:PIZZICA, MARY (LCSWC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:PIZZICA
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:RIFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4010
Mailing Address - Country:US
Mailing Address - Phone:410-522-1181
Mailing Address - Fax:410-522-1182
Practice Address - Street 1:200 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2671
Practice Address - Country:US
Practice Address - Phone:410-962-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical