Provider Demographics
NPI:1255649018
Name:ENCARNACION, ZULLY
Entity Type:Individual
Prefix:
First Name:ZULLY
Middle Name:
Last Name:ENCARNACION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DIXWELL ST
Mailing Address - Street 2:APT 1
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3144
Mailing Address - Country:US
Mailing Address - Phone:857-492-4708
Mailing Address - Fax:
Practice Address - Street 1:21 DIXWELL ST
Practice Address - Street 2:APT 1
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-3144
Practice Address - Country:US
Practice Address - Phone:857-492-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health