Provider Demographics
NPI:1245242254
Name:ZEIBEN, KATHY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:ZEIBEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1115
Mailing Address - Country:US
Mailing Address - Phone:413-549-0694
Mailing Address - Fax:
Practice Address - Street 1:1236 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5370
Practice Address - Country:US
Practice Address - Phone:413-406-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1118411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAZEP06640Medicare ID - Type Unspecified