Healthcare Provider Details

I. General information

NPI: 1972945962
Provider Name (Legal Business Name): FRANK PETER ZACHARIAS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17844 E 23RD ST S
INDEPENDENCE MO
64057-1840
US

IV. Provider business mailing address

17844 E 23RD ST S
INDEPENDENCE MO
64057-1840
US

V. Phone/Fax

Practice location:
  • Phone: 816-254-3652
  • Fax: 816-254-9243
Mailing address:
  • Phone: 816-254-3652
  • Fax: 816-254-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2013014809
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: