Healthcare Provider Details

I. General information

NPI: 1366772774
Provider Name (Legal Business Name): JEFFREY R ZINBARG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 E STADIUM BLVD SUITE B4
ANN ARBOR MI
48104-4833
US

IV. Provider business mailing address

2311 E STADIUM BLVD SIUTE B4
ANN ARBOR MI
48104-4833
US

V. Phone/Fax

Practice location:
  • Phone: 734-904-0382
  • Fax:
Mailing address:
  • Phone: 734-904-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: