Provider Demographics
NPI:1205600202
Name:REID, ZACHARY ROBERT (MSW, CSW)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ROBERT
Last Name:REID
Suffix:
Gender:M
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 INDUSTRY RD
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-9140
Mailing Address - Country:US
Mailing Address - Phone:859-239-9598
Mailing Address - Fax:
Practice Address - Street 1:975 HUSTONVILLE RD STE 7
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2165
Practice Address - Country:US
Practice Address - Phone:859-239-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2583541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical