Provider Demographics
NPI:1649690520
Name:ZAMBRANO, ANTHONY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ZAMBRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 RANGE RD
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:ME
Mailing Address - Zip Code:04426-6001
Mailing Address - Country:US
Mailing Address - Phone:207-664-8343
Mailing Address - Fax:
Practice Address - Street 1:77 UNION ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1537
Practice Address - Country:US
Practice Address - Phone:207-667-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS6427320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness