Healthcare Provider Details

I. General information

NPI: 1457867384
Provider Name (Legal Business Name): MR. WILLIAM THOMAS ZAFFIRO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 KNIFFEN RD
PAINESVILLE OH
44077-8858
US

IV. Provider business mailing address

7630 KNIFFEN RD
PAINESVILLE OH
44077-8858
US

V. Phone/Fax

Practice location:
  • Phone: 216-408-1587
  • Fax:
Mailing address:
  • Phone: 216-408-1587
  • Fax: 216-404-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1901140-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCS.00001827
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1500716
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: