Provider Demographics
NPI:1063500395
Name:ZIELINSKI, SEAN (PHD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:ZIELINSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:
Other - Last Name:ZIELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4955 SEPULVEDA
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-367-0198
Mailing Address - Fax:
Practice Address - Street 1:916 W OWENS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2516
Practice Address - Country:US
Practice Address - Phone:702-636-4060
Practice Address - Fax:702-636-4079
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical