Healthcare Provider Details

I. General information

NPI: 1831559970
Provider Name (Legal Business Name): TINA ZAPETIS MSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER ROAD OUTPATIENT BEHAVIORAL HEALTH- WOODBURY 1
CLIFTON SPRINGS NY
14332
US

IV. Provider business mailing address

2 COULTER ROAD OUTPATIENT BEHAVIORAL HEALTH- WOODBURY 1
CLIFTON SPRINGS NY
14332
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-1050
  • Fax: 315-462-0145
Mailing address:
  • Phone: 315-462-1050
  • Fax: 315-462-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: