Provider Demographics
NPI:1295910461
Name:ZETDEFF, JOHN T (ANALYTIC PSYCHOTHERA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:ZETDEFF
Suffix:
Gender:F
Credentials:ANALYTIC PSYCHOTHERA
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:T
Other - Last Name:ZETDEFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANALYTIC PSYCHOTHERA
Mailing Address - Street 1:11 HAMLET CT
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4448
Mailing Address - Country:US
Mailing Address - Phone:845-297-9306
Mailing Address - Fax:
Practice Address - Street 1:11 HAMLET CT
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4448
Practice Address - Country:US
Practice Address - Phone:845-297-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000614-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst