Provider Demographics
NPI:1376985994
Name:ZISER, SHIRLEY (LCSW)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ZISER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 14010
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96543-4010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36TH MEDICAL GROUP
Practice Address - Street 2:UNIT 14010 BLDG. 26012
Practice Address - City:APO AP
Practice Address - State:GU
Practice Address - Zip Code:96543-4003
Practice Address - Country:US
Practice Address - Phone:315-366-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67211041C0700X
KY5070104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID