Provider Demographics
NPI:1497852503
Name:FELIZZI, MARC V (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:V
Last Name:FELIZZI
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MILLTOWN RD STE 22
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4084
Mailing Address - Country:US
Mailing Address - Phone:302-897-4942
Mailing Address - Fax:302-998-7670
Practice Address - Street 1:1601 MILLTOWN RD STE 22
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4084
Practice Address - Country:US
Practice Address - Phone:302-897-4942
Practice Address - Fax:302-998-7670
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100004901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE11701529OtherCAQH
DE000593172Medicaid