Provider Demographics
NPI:1740420785
Name:PREZZANO, DONNA ROSE (LICSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ROSE
Last Name:PREZZANO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:STE 430G
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6500
Mailing Address - Country:US
Mailing Address - Phone:978-491-0638
Mailing Address - Fax:978-921-0044
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:STE 430G
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6500
Practice Address - Country:US
Practice Address - Phone:978-491-0638
Practice Address - Fax:978-921-0044
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1158111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical