Provider Demographics
NPI:1952636110
Name:ZENGA, NICOLE T
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:T
Last Name:ZENGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HARMONY DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:ME
Mailing Address - Zip Code:04346-5403
Mailing Address - Country:US
Mailing Address - Phone:207-441-2877
Mailing Address - Fax:
Practice Address - Street 1:14 MAINE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2049
Practice Address - Country:US
Practice Address - Phone:207-373-0620
Practice Address - Fax:207-373-0628
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical