Healthcare Provider Details

I. General information

NPI: 1669490728
Provider Name (Legal Business Name): DAVID OLIVER ZOOK LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S PROSPECT ST
HAGERSTOWN MD
21740-5409
US

IV. Provider business mailing address

113 S PROSPECT ST
HAGERSTOWN MD
21740-5409
US

V. Phone/Fax

Practice location:
  • Phone: 301-745-1900
  • Fax: 301-745-4110
Mailing address:
  • Phone: 301-745-1900
  • Fax: 301-745-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00184
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: