Provider Demographics
NPI:1295357499
Name:PRESTON, ZACH (CSP)
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:PRESTON
Suffix:
Gender:M
Credentials:CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1207
Mailing Address - Country:US
Mailing Address - Phone:603-412-2059
Mailing Address - Fax:
Practice Address - Street 1:72 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NH
Practice Address - Zip Code:03251-4441
Practice Address - Country:US
Practice Address - Phone:603-745-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH114180103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty