Provider Demographics
NPI:1285250811
Name:ZUTRAU, AUDREY MARGARET (BA)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARGARET
Last Name:ZUTRAU
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 ASPINWALL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6959
Mailing Address - Country:US
Mailing Address - Phone:617-304-3532
Mailing Address - Fax:
Practice Address - Street 1:3313 WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2691
Practice Address - Country:US
Practice Address - Phone:508-209-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor