Provider Demographics
NPI:1124310016
Name:SAKHAT, ZAZA SAMIR (LICSW)
Entity type:Individual
Prefix:MS
First Name:ZAZA
Middle Name:SAMIR
Last Name:SAKHAT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 COPELAND ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4081
Mailing Address - Country:US
Mailing Address - Phone:617-786-0137
Mailing Address - Fax:
Practice Address - Street 1:234 COPELAND ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4081
Practice Address - Country:US
Practice Address - Phone:617-786-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1144831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical