Healthcare Provider Details

I. General information

NPI: 1225722648
Provider Name (Legal Business Name): SAMUEL R ZUBELLA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

IV. Provider business mailing address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4000
  • Fax: 608-824-4938
Mailing address:
  • Phone: 608-824-4000
  • Fax: 608-824-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11237
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: