Provider Demographics
NPI:1871785089
Name:ZATKIN, DEBRA BOSTOCKY (LCSW-C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:BOSTOCKY
Last Name:ZATKIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 RITCHIE HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2743
Mailing Address - Country:US
Mailing Address - Phone:410-757-8137
Mailing Address - Fax:410-757-3916
Practice Address - Street 1:1507 RITCHIE HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2743
Practice Address - Country:US
Practice Address - Phone:410-757-8137
Practice Address - Fax:410-757-3916
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD048991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD538SMedicare PIN