Healthcare Provider Details

I. General information

NPI: 1518047778
Provider Name (Legal Business Name): ZAIDA I GOVAN MSW, LADC1, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 BERKSHIRE AVE
INDIAN ORCHARD MA
01151-1367
US

IV. Provider business mailing address

1042 BERKSHIRE AVE
INDIAN ORCHARD MA
01151-1367
US

V. Phone/Fax

Practice location:
  • Phone: 413-301-2533
  • Fax:
Mailing address:
  • Phone: 413-301-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number217644
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2289
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: