Provider Demographics
NPI:1679712038
Name:ZACKMAN, ROBERTA SUE (LMHC)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:SUE
Last Name:ZACKMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BROADLAWN PARK
Mailing Address - Street 2:SUITE 23A
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3526
Mailing Address - Country:US
Mailing Address - Phone:617-327-4250
Mailing Address - Fax:617-467-5538
Practice Address - Street 1:57 BROADLAWN PARK
Practice Address - Street 2:SUITE 23A
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3526
Practice Address - Country:US
Practice Address - Phone:617-327-4250
Practice Address - Fax:617-467-5538
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health