Provider Demographics
NPI:1295561561
Name:ZELLER, AUSTIN
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:ZELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08752-2124
Mailing Address - Country:US
Mailing Address - Phone:908-334-3907
Mailing Address - Fax:
Practice Address - Street 1:13 PARK AVE APT A
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1544
Practice Address - Country:US
Practice Address - Phone:509-412-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health