Healthcare Provider Details

I. General information

NPI: 1538490164
Provider Name (Legal Business Name): NICOLENE MARY ZAPACH M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BIRCH AVE
MOUNT LEBANON PA
15228-2320
US

IV. Provider business mailing address

206 BIRCH AVE
MOUNT LEBANON PA
15228-2320
US

V. Phone/Fax

Practice location:
  • Phone: 412-561-3815
  • Fax:
Mailing address:
  • Phone: 412-561-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007382L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: