Healthcare Provider Details

I. General information

NPI: 1871740498
Provider Name (Legal Business Name): ZACHARY MOONEY LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 MOTTER AVE OFC
FREDERICK MD
21701-4595
US

IV. Provider business mailing address

10 N JEFFERSON ST SUITE 203
FREDERICK MD
21701-3500
US

V. Phone/Fax

Practice location:
  • Phone: 240-397-9259
  • Fax:
Mailing address:
  • Phone: 301-712-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3647
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: