Provider Demographics
NPI:1073717054
Name:ZAVAREEI, ANNETTE MARINO (ED D)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARINO
Last Name:ZAVAREEI
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DEMING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1013
Mailing Address - Country:US
Mailing Address - Phone:304-346-5006
Mailing Address - Fax:
Practice Address - Street 1:404 OLD MAIN DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1360
Practice Address - Country:US
Practice Address - Phone:304-872-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV100002103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool