Healthcare Provider Details

I. General information

NPI: 1326688474
Provider Name (Legal Business Name): MERIDETH KATE ZIDE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FEDERAL ST
GREENFIELD MA
01301-2546
US

IV. Provider business mailing address

20 PHYLLIS LN APT D
GREENFIELD MA
01301-9532
US

V. Phone/Fax

Practice location:
  • Phone: 413-772-2935
  • Fax:
Mailing address:
  • Phone: 508-801-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: