Provider Demographics
NPI:1487406641
Name:ZINKIEWICZ, CRAIG JOSEPH (PSYD, NCSP)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JOSEPH
Last Name:ZINKIEWICZ
Suffix:
Gender:M
Credentials:PSYD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E MISSOURI AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2443
Mailing Address - Country:US
Mailing Address - Phone:602-274-1928
Mailing Address - Fax:
Practice Address - Street 1:1515 E MISSOURI AVE STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2443
Practice Address - Country:US
Practice Address - Phone:602-274-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005426103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty