Healthcare Provider Details

I. General information

NPI: 1497909907
Provider Name (Legal Business Name): GERALD W. ZACHAR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 09/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 EUCLID AVE SUITE D
ROLLING MEADOWS IL
60008-2083
US

IV. Provider business mailing address

391 N PONDVIEW DR
PALATINE IL
60067-8021
US

V. Phone/Fax

Practice location:
  • Phone: 847-721-6466
  • Fax:
Mailing address:
  • Phone: 847-721-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-010194
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: