Provider Demographics
NPI:1093780249
Name:ZAKRESKI, RICHARD SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:ZAKRESKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AVENUE AT THE CMN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4800
Mailing Address - Country:US
Mailing Address - Phone:732-544-9079
Mailing Address - Fax:732-544-9079
Practice Address - Street 1:40 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 203
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4800
Practice Address - Country:US
Practice Address - Phone:732-544-9079
Practice Address - Fax:732-544-9079
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1922103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical