Healthcare Provider Details

I. General information

NPI: 1366677460
Provider Name (Legal Business Name): ZOE K OKOLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZOE K RADEMEYER LICSW

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 TURNPIKE ST SUITE 1
CANTON MA
02021-2700
US

IV. Provider business mailing address

340 TURNPIKE ST SUITE 1
CANTON MA
02021-2700
US

V. Phone/Fax

Practice location:
  • Phone: 781-619-1523
  • Fax:
Mailing address:
  • Phone: 781-619-1523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117128
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: