Provider Demographics
NPI:1942391917
Name:ZEMBOW, MICHELE T (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:T
Last Name:ZEMBOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PLYMOUTH PL
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2322
Mailing Address - Country:US
Mailing Address - Phone:973-762-7227
Mailing Address - Fax:
Practice Address - Street 1:18 PLYMOUTH PL
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2322
Practice Address - Country:US
Practice Address - Phone:973-762-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00270700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist