Provider Demographics
NPI:1285124578
Name:ZOLIT, ETHAN LOUIS
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:LOUIS
Last Name:ZOLIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1902
Mailing Address - Country:US
Mailing Address - Phone:617-429-1480
Mailing Address - Fax:
Practice Address - Street 1:9 EVERETT ST
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1902
Practice Address - Country:US
Practice Address - Phone:617-429-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician