Provider Demographics
NPI:1316973993
Name:ZACKS, ELEANOR
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:ZACKS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:ZACKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:9700 FAIR OAKS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7079
Mailing Address - Country:US
Mailing Address - Phone:916-863-1790
Mailing Address - Fax:
Practice Address - Street 1:9700 FAIR OAKS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7079
Practice Address - Country:US
Practice Address - Phone:916-863-1790
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10426103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY10426Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST