Healthcare Provider Details

I. General information

NPI: 1699067637
Provider Name (Legal Business Name): LAURA ELLEN ZINN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HIGH STREET
NEWTON NJ
07860
US

IV. Provider business mailing address

175 HIGH STREET
NEWTON NJ
07860
US

V. Phone/Fax

Practice location:
  • Phone: 973-383-1533
  • Fax:
Mailing address:
  • Phone: 973-383-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00578400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: