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General NPI Number Information
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NPI Number | 1144821497
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Entity Type | Individual
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Provider Name | MICHAEL EARL ZWIRBLIA PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 3512 QUENTIN RD
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City | BROOKLYN
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State | NY
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Zip | 11234-4244
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Country | US
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Telephone | 800-275-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 517 W 161ST ST APT 32
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City | NEW YORK
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State | NY
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Zip | 10032-6110
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Country | US
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Telephone | 772-203-7404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 024066
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 000000
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License Number State | NY
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