Provider Demographics
NPI:1538144746
Name:ZWETCHKENBAUM, KEVIN PETER (LICSW CADAC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PETER
Last Name:ZWETCHKENBAUM
Suffix:
Gender:M
Credentials:LICSW CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1373
Mailing Address - Country:US
Mailing Address - Phone:508-429-6800
Mailing Address - Fax:508-429-6844
Practice Address - Street 1:118 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1373
Practice Address - Country:US
Practice Address - Phone:508-429-6800
Practice Address - Fax:508-429-6844
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACADACAD5909101YA0400X
MA10170031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical