Healthcare Provider Details

I. General information

NPI: 1437402344
Provider Name (Legal Business Name): ZINE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715B WASHINGTON ST
CANTON MA
02021-3037
US

IV. Provider business mailing address

715B WASHINGTON ST
CANTON MA
02021-3037
US

V. Phone/Fax

Practice location:
  • Phone: 781-713-4040
  • Fax:
Mailing address:
  • Phone: 781-713-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116099
License Number StateMA

VIII. Authorized Official

Name: MELISSA ZINE
Title or Position: OWNER
Credential: LICSW
Phone: 781-713-4040