Provider Demographics
NPI:1972804029
Name:DERENZO, MARY C (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:DERENZO
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9981 WASHINGTON ST STE 10
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2165
Mailing Address - Country:US
Mailing Address - Phone:303-500-9464
Mailing Address - Fax:720-929-0121
Practice Address - Street 1:9981 WASHINGTON ST STE 10
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2165
Practice Address - Country:US
Practice Address - Phone:303-500-9464
Practice Address - Fax:720-929-0121
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional