Provider Demographics
NPI:1518486711
Name:ZINCKGRAF, KATHY (BA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ZINCKGRAF
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT MURRAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07865-3237
Mailing Address - Country:US
Mailing Address - Phone:908-399-2470
Mailing Address - Fax:
Practice Address - Street 1:12 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PORT MURRAY
Practice Address - State:NJ
Practice Address - Zip Code:07865-3237
Practice Address - Country:US
Practice Address - Phone:908-399-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst