Healthcare Provider Details

I. General information

NPI: 1871785089
Provider Name (Legal Business Name): DEBRA BOSTOCKY ZATKIN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2007
Last Update Date: 08/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 RITCHIE HWY SUITE 102
ARNOLD MD
21012-2743
US

IV. Provider business mailing address

1507 RITCHIE HWY SUITE 102
ARNOLD MD
21012-2743
US

V. Phone/Fax

Practice location:
  • Phone: 410-757-8137
  • Fax: 410-757-3916
Mailing address:
  • Phone: 410-757-8137
  • Fax: 410-757-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04899
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: