Provider Demographics
NPI:1649604091
Name:ZAK-WATT, DOREEN MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:MARIE
Last Name:ZAK-WATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:355 HARLEM ROAD
Mailing Address - Street 2:BOCES ERIE I
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-821-7000
Mailing Address - Fax:716-821-7218
Practice Address - Street 1:10150 GREINER RD.
Practice Address - Street 2:CLARENCE MIDDLE SCHOOL
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031
Practice Address - Country:US
Practice Address - Phone:716-407-9209
Practice Address - Fax:716-407-9243
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027370-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker