Healthcare Provider Details

I. General information

NPI: 1093739070
Provider Name (Legal Business Name): DONALD ZALL LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BAKER AVENUE EXTENSION
CONCORD MA
01742-2188
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-9380
  • Fax: 978-287-6199
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103183
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: