MEDICARE: MR. KEVIN PETER ZWETCHKENBAUM LICSW CADAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CADACAD5909	MA
2	1041C0700X	Clinical Social Worker	1017003	MA

General Provider Information

NPI Number	:	1538144746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN PETER ZWETCHKENBAUM LICSW CADAC

Provider Business Mailing Address
First Line	:	118 WASHINGTON ST
Second Line	:
City	:	HOLLISTON
State	:	MA
Zip	:	01746-1373
Country	:	US
Telephone Number	:	508-429-6800
Fax Number	:	508-429-6844

Provider Business Practice Location Address
First Line	:	118 WASHINGTON ST
Second Line	:
City	:	HOLLISTON
State	:	MA
Zip	:	01746-1373
Country	:	US
Telephone Number	:	508-429-6800
Fax Number	:	508-429-6844

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	09/11/2025

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