Phillip Zagozewski
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · South Waverly, PA
NPI 1013191964 · NPPES record last updated Dec 27, 2007
Key facts
- NPI
- 1013191964
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- Practice address
- 356 Loder St
South Waverly, PA 18840-2611 - Phone
- (570) 882-7414
- Fax
- (570) 888-1204
- NPI assigned
- Dec 27, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Tier Counseling, Inc. | Past | Accepting new patients |
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/northerntiercounseling/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Yes |
Addresses
Primary practice location
356 Loder St
South Waverly, PA 18840-2611
Mailing address
356 Loder St
South Waverly, PA 18840-2611
Phone (570) 882-7414
Other providers in South Waverly, PA
All providers in South Waverly, PA · Addiction (Substance Use Disorder) Counselor in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.