Healthcare Provider Details

I. General information

NPI: 1982308441
Provider Name (Legal Business Name): MICHAEL ZALESKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 AUTH RD
SUITLAND MD
20746-4339
US

IV. Provider business mailing address

1161 RAMBLEWOOD DR
ANNAPOLIS MD
21409-4668
US

V. Phone/Fax

Practice location:
  • Phone: 202-257-6632
  • Fax:
Mailing address:
  • Phone: 443-852-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: