Provider Demographics
NPI:1154927226
Name:ZADAKA, AVI-NATAN (LCSW)
Entity type:Individual
Prefix:
First Name:AVI-NATAN
Middle Name:
Last Name:ZADAKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 WILLOUGHBY WAY E
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5414
Mailing Address - Country:US
Mailing Address - Phone:763-442-7238
Mailing Address - Fax:
Practice Address - Street 1:777 29TH ST STE 500
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2357
Practice Address - Country:US
Practice Address - Phone:763-442-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN280381041C0700X
CO099287811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical