Healthcare Provider Details

I. General information

NPI: 1992366603
Provider Name (Legal Business Name): AGATA ZIETEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 CENTER ST
MANCHESTER CT
06040-3926
US

IV. Provider business mailing address

700 BLOOMFIELD AVE UNIT 334
BLOOMFIELD CT
06002-4239
US

V. Phone/Fax

Practice location:
  • Phone: 860-338-9670
  • Fax:
Mailing address:
  • Phone: 315-382-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: