Healthcare Provider Details

I. General information

NPI: 1538705553
Provider Name (Legal Business Name): ZAZRAK, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 LEOMINSTER STREET SUITE 335
LEOMINSTER MA
01453
US

IV. Provider business mailing address

46 S. ASHBURNHAM ROAD
WESTMINSLER MA
01473
US

V. Phone/Fax

Practice location:
  • Phone: 919-633-0049
  • Fax: 508-342-7542
Mailing address:
  • Phone: 919-633-0049
  • Fax: 508-342-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DESDALIN C. BLACK
Title or Position: CEO/BCBA
Credential: M.S. ED., BCBA,LABA
Phone: 419-633-0049