Healthcare Provider Details

I. General information

NPI: 1063858942
Provider Name (Legal Business Name): JAMES ZAGRES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CHASE RIVER RD
WATERBURY CT
06704-1408
US

IV. Provider business mailing address

22 CHASE RIVER RD
WATERBURY CT
06704-1408
US

V. Phone/Fax

Practice location:
  • Phone: 203-753-2153
  • Fax: 203-756-6032
Mailing address:
  • Phone: 203-753-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008296
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: