Healthcare Provider Details

I. General information

NPI: 1598613713
Provider Name (Legal Business Name): ZACHAH KOUFALIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ZACHAH GERMAN LMSW

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BEDFORD PARK BLVD E
BRONX NY
10468-1771
US

IV. Provider business mailing address

36 PENGILLY DR
NEW ROCHELLE NY
10804-3016
US

V. Phone/Fax

Practice location:
  • Phone: 332-298-3502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number073873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: