1033875166 NPI number — DAWNMARIE SARAH ZAKOWICZ LMSW

Table of content: DAWNMARIE SARAH ZAKOWICZ LMSW (NPI 1033875166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033875166 NPI number — DAWNMARIE SARAH ZAKOWICZ LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAKOWICZ
Provider First Name:
DAWNMARIE
Provider Middle Name:
SARAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASEY
Provider Other First Name:
DAWNMARIE
Provider Other Middle Name:
SARAH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033875166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12212-4890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 BURDETT AVENUE
Provider Second Line Business Practice Location Address:
SAMARITAN CAMPUS BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-2466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-271-3554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  062561 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)