Provider Demographics
NPI:1003924226
Name:REZENDES, GLADYS V (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:V
Last Name:REZENDES
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 COMSTOCK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907
Mailing Address - Country:US
Mailing Address - Phone:401-621-5882
Mailing Address - Fax:501-621-8463
Practice Address - Street 1:118 COMSTOCK AVENUE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907
Practice Address - Country:US
Practice Address - Phone:401-621-5882
Practice Address - Fax:501-621-8463
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISWOO425103T00000X
MA1017865103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist