Basic Information
| Provider Information | |||||||||
| NPI: | 1073843405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZABARSKY | ||||||||
| FirstName: | ANHDAO | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2155 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011043301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137360395 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2155 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011043301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137360395 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2010 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 000000008465 | 01 | MA | BOSTON MEDICAL CENTER HEALTH NET PLAN | OTHER | 1306839 | 05 | MA | MEDICAID |