Provider Demographics
NPI:1275235731
Name:ZACK, OWEN
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:ZACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1937
Mailing Address - Country:US
Mailing Address - Phone:301-233-7514
Mailing Address - Fax:
Practice Address - Street 1:7124 PANORAMA DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-1937
Practice Address - Country:US
Practice Address - Phone:301-233-7514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health