Healthcare Provider Details

I. General information

NPI: 1639370166
Provider Name (Legal Business Name): RONALD ZAGAJA LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 TURNPIKE ST SUITE 81
NORTH ANDOVER MA
01845-5922
US

IV. Provider business mailing address

565 TURNPIKE ST SUITE 81
NORTH ANDOVER MA
01845-5922
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-1579
  • Fax: 978-689-4582
Mailing address:
  • Phone: 978-682-1579
  • Fax: 978-689-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101975
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: