Basic Information
Provider Information
NPI: 1881669083
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAMORA
FirstName: DANIEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LISW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8227 BRECKSVILLE RD
Address2: 104
City: BRECKSVILLE
State: OH
PostalCode: 441411370
CountryCode: US
TelephoneNumber: 4405260468
FaxNumber: 4405260454
Practice Location
Address1: 8227 BRECKSVILLE RD
Address2: 104
City: BRECKSVILLE
State: OH
PostalCode: 441411370
CountryCode: US
TelephoneNumber: 4405260468
FaxNumber: 4405260454
Other Information
ProviderEnumerationDate: 02/21/2006
LastUpdateDate: 06/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XI2833OHY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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