Provider Demographics
NPI:1669193694
Name:REZENDES, GRACE (LMHC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:REZENDES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1218
Mailing Address - Country:US
Mailing Address - Phone:860-608-2442
Mailing Address - Fax:
Practice Address - Street 1:14 CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1218
Practice Address - Country:US
Practice Address - Phone:860-608-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health