Provider Demographics
NPI:1285672808
Name:GHEZZI, MARILYN ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANN
Last Name:GHEZZI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CALDWELL EXT
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2065
Mailing Address - Country:US
Mailing Address - Phone:919-913-4200
Mailing Address - Fax:919-913-4201
Practice Address - Street 1:412 CALDWELL EXT
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-2065
Practice Address - Country:US
Practice Address - Phone:919-913-4200
Practice Address - Fax:919-913-4201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0008061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2866866AMedicare ID - Type Unspecified