Healthcare Provider Details

I. General information

NPI: 1710425640
Provider Name (Legal Business Name): ZACHARY HOLTZMAN-CONSTON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2017
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EAST 95TH STREET
NEW YORK NY
10128-4077
US

IV. Provider business mailing address

92 ORCHARD ST # 3
NEW YORK NY
10002-3126
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-8000
  • Fax: 212-423-3127
Mailing address:
  • Phone: 215-917-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number020402
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092944
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: