Provider Demographics
NPI:1417103474
Name:VANZANT, FRED M (LICSW)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:M
Last Name:VANZANT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SEAN CIR
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3780
Mailing Address - Country:US
Mailing Address - Phone:978-667-8589
Mailing Address - Fax:
Practice Address - Street 1:8 SEAN CIR
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3780
Practice Address - Country:US
Practice Address - Phone:978-667-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1168941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical