Provider Demographics
NPI:1861781676
Name:ZAVASKY, DAVID J (PC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:ZAVASKY
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 TREESIDE ST NW
Mailing Address - Street 2:APT A
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-1957
Mailing Address - Country:US
Mailing Address - Phone:330-478-4543
Mailing Address - Fax:
Practice Address - Street 1:625 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1805
Practice Address - Country:US
Practice Address - Phone:330-455-0374
Practice Address - Fax:330-455-2101
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH900624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098331Medicaid