Provider Demographics
NPI:1265985261
Name:KING, ZACKARY (MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:ZACKARY
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:MR
Other - First Name:ZACHARY
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:49 PARK PL
Mailing Address - Street 2:APT #6
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3526
Mailing Address - Country:US
Mailing Address - Phone:862-500-1333
Mailing Address - Fax:
Practice Address - Street 1:49 PARK PL
Practice Address - Street 2:APT #6
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3526
Practice Address - Country:US
Practice Address - Phone:862-500-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06129200104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker