Provider Demographics
NPI:1376963843
Name:ZICK, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ZICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70-71 N PARISH RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2914
Mailing Address - Country:US
Mailing Address - Phone:978-722-8391
Mailing Address - Fax:978-681-5209
Practice Address - Street 1:70-71 N PARISH RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2914
Practice Address - Country:US
Practice Address - Phone:978-686-8521
Practice Address - Fax:978-681-5209
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1205101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical