Healthcare Provider Details

I. General information

NPI: 1760300479
Provider Name (Legal Business Name): ZACHARY THOMAS BRUBACK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 E 141ST ST
MAPLE HEIGHTS OH
44137-3803
US

IV. Provider business mailing address

5700 E 141ST ST
MAPLE HEIGHTS OH
44137-3803
US

V. Phone/Fax

Practice location:
  • Phone: 216-200-7878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: