Provider Demographics
NPI:1104043793
Name:ZAZOW, BETSY (LCSW)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:ZAZOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4252
Mailing Address - Country:US
Mailing Address - Phone:215-345-6252
Mailing Address - Fax:
Practice Address - Street 1:22 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4252
Practice Address - Country:US
Practice Address - Phone:215-345-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2051717000OtherINDEPENDENCE BLUE CROSS
PAZA-651537Medicare ID - Type Unspecified