Healthcare Provider Details

I. General information

NPI: 1467552109
Provider Name (Legal Business Name): SANDRA ZAWALICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA HARRINGTON

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ROLLING HILLS BLVD
MONTICELLO KY
42633-9005
US

IV. Provider business mailing address

80 ROLLING HILLS BLVD
MONTICELLO KY
42633-9005
US

V. Phone/Fax

Practice location:
  • Phone: 606-343-0216
  • Fax: 606-343-0224
Mailing address:
  • Phone: 606-343-0216
  • Fax: 606-343-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000608
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1026325
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number258483
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: