Healthcare Provider Details

I. General information

NPI: 1659580397
Provider Name (Legal Business Name): MICHAEL ZWALSKY ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 HIGH ST
WESTWOOD MA
02090-2503
US

IV. Provider business mailing address

776 HIGH ST
WESTWOOD MA
02090-2503
US

V. Phone/Fax

Practice location:
  • Phone: 508-890-6404
  • Fax: 508-890-6410
Mailing address:
  • Phone: 508-890-6404
  • Fax: 508-890-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3807
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: