Provider Demographics
NPI:1053514307
Name:ZISK, MARGARET MARY (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:MARY
Last Name:ZISK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 USHER RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2233
Mailing Address - Country:US
Mailing Address - Phone:781-391-6545
Mailing Address - Fax:
Practice Address - Street 1:35A MEMORIAL RD APT 12
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1706
Practice Address - Country:US
Practice Address - Phone:617-629-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113114104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker