Provider Demographics
NPI:1770797086
Name:ZELAZOWSKI, RONALD RAYMOND (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RAYMOND
Last Name:ZELAZOWSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SECOND AVENUE
Mailing Address - Street 2:STE 209
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2434
Mailing Address - Country:US
Mailing Address - Phone:814-726-9798
Mailing Address - Fax:
Practice Address - Street 1:315 SECOND AVENUE
Practice Address - Street 2:STE 209
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2434
Practice Address - Country:US
Practice Address - Phone:814-726-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004379L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP023804OtherTRICARE
R07334Medicare UPIN