=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669181525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MILANA ZANZURI LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2022
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 EASTBROOK RD STE 103
-----------------------------------------------------
City | DEDHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02026-2083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-360-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 935 GREAT PLAIN AVE # 125
-----------------------------------------------------
City | NEEDHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02492-3031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 228552
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------