MEDICARE: EDWARD J. ZDENEK SC.D.

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
1	103TB0200X	Cognitive & Behavioral Psychologist	2784	MA

General Provider Information

NPI Number	:	1235113135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD J. ZDENEK SC.D.

Provider Business Mailing Address
First Line	:	770 WASHINGTON ST.
Second Line	:	SUITE 3
City	:	HOLLISTON
State	:	MA
Zip	:	01746
Country	:	US
Telephone Number	:	508-429-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	770 WASHINGTON ST.
Second Line	:	SUITE 3
City	:	HOLLISTON
State	:	MA
Zip	:	01746
Country	:	US
Telephone Number	:	508-429-7311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2005
Last Update Date	:	01/04/2011

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