Provider Demographics
NPI:1649841933
Name:ZACK, MONICA (LSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:ZACK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 SPRING GARDEN ST # 2F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-5000
Mailing Address - Country:US
Mailing Address - Phone:610-742-7728
Mailing Address - Fax:
Practice Address - Street 1:2043 SPRING GARDEN ST # 2F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-5000
Practice Address - Country:US
Practice Address - Phone:610-742-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138252104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker