Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2784 | MA |
NPI | 1235113135 |
---|---|
Provider Name | Edward J. Zdenek |
First Address | Holliston, MA 01746 |
Second Address | Holliston, MA 01746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2005 |
Last Update Date | 04/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R44378 | (02) | |
R44378 | (02) | MA |