Provider Demographics
NPI:1134980667
Name:RZASA, MARY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:RZASA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 FEDERAL RD STE C33
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2648
Mailing Address - Country:US
Mailing Address - Phone:475-529-7092
Mailing Address - Fax:203-546-7175
Practice Address - Street 1:246 FEDERAL RD STE C33
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2648
Practice Address - Country:US
Practice Address - Phone:475-529-7092
Practice Address - Fax:203-546-7175
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker