Provider Demographics
NPI:1649343435
Name:ZANOR, CHARLES W (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:ZANOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1540
Mailing Address - Country:US
Mailing Address - Phone:413-736-8158
Mailing Address - Fax:413-736-0140
Practice Address - Street 1:1111 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1540
Practice Address - Country:US
Practice Address - Phone:413-736-8158
Practice Address - Fax:413-736-0140
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY 2319 PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02568Medicare ID - Type Unspecified