Provider Demographics
NPI:1538694864
Name:ZAGER, MICHELE (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ZAGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-7130
Mailing Address - Country:US
Mailing Address - Phone:401-595-3280
Mailing Address - Fax:
Practice Address - Street 1:269 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-7130
Practice Address - Country:US
Practice Address - Phone:401-595-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist