Provider Demographics
NPI:1538879143
Name:PAGE, ZETTIE D III (LCSW)
Entity type:Individual
Prefix:DR
First Name:ZETTIE
Middle Name:D
Last Name:PAGE
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAY AREA COMMUNITY HEALTH
Mailing Address - Street 2:40910 FREMONT BLVD
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:760-902-5249
Mailing Address - Fax:
Practice Address - Street 1:BAY AREA COMMUNITY HEALTH
Practice Address - Street 2:40910 FREMONT BLVD
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:760-902-5249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health