Healthcare Provider Details

I. General information

NPI: 1013179084
Provider Name (Legal Business Name): ELIZABETH A ZAHORUIKO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WATERVILLE RD
AVON CT
06001-2097
US

IV. Provider business mailing address

57 WOODHENGE DR
TOLLAND CT
06084-3537
US

V. Phone/Fax

Practice location:
  • Phone: 860-284-0182
  • Fax:
Mailing address:
  • Phone: 860-426-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003447
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: