Individual
CAROL S ZACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
95 EXCHANGE ST, PORTLAND, ME 04101
(207) 871-1000
(207) 773-0472
Mailing address
95 EXCHANGE ST, PORTLAND, ME 04101
(207) 871-1000
(207) 773-0472
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC5688
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027257
ANTHEM
—
01
—
7288012
AETNA
—
Enumeration date
09/07/2006
Last updated
07/08/2007
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