Healthcare Provider Details

I. General information

NPI: 1275528473
Provider Name (Legal Business Name): JOANNE ZAGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PARK LN
ITHACA NY
14850-6352
US

IV. Provider business mailing address

118 PARK LN
ITHACA NY
14850-6352
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-6353
  • Fax: 607-272-6353
Mailing address:
  • Phone: 607-272-6353
  • Fax: 607-272-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: