Healthcare Provider Details

I. General information

NPI: 1568569267
Provider Name (Legal Business Name): RANDY ENID ZAMERINSKY-LUSSIER MA, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

IMA-EUROPE ATTN: SFIM-EU-HR(SAIC-ASACS) UNIT 29353, BOX 200
APO AE
09014-9353
US

IV. Provider business mailing address

IMA-EUROPE ATTN: SFIM-EU-HR(SAIC-ASACS) UNIT 29353, BOX 200
APO AE
09014-9353
US

V. Phone/Fax

Practice location:
  • Phone: 496221163912
  • Fax: 496221578943
Mailing address:
  • Phone: 496221163912
  • Fax: 496221578943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06001
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: