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NPI Code Detail

MEDICARE: AVI-NATAN ZADAKA LCSW

MEDICARE: AVI-NATAN ZADAKA LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker28038MN
21041C0700XClinical Social Worker09928781CO

General Provider Information

NPI Number : 1154927226
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVI-NATAN ZADAKA LCSW
Provider Business Mailing Address
First Line : 569 WILLOUGHBY WAY E
Second Line :
City : HOPKINS
State : MN
Zip : 55305-5414
Country : US
Telephone Number : 763-442-7238
Fax Number :
Provider Business Practice Location Address
First Line : 777 29TH ST STE 500
Second Line :
City : BOULDER
State : CO
Zip : 80303-2357
Country : US
Telephone Number : 763-442-7238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2020
Last Update Date : 02/27/2023

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Directions to “ AVI-NATAN ZADAKA LCSW” Practice Location

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