Healthcare Provider Details

I. General information

NPI: 1346307972
Provider Name (Legal Business Name): CHRISTINE ZICCARDI L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E ST SUITE 310
DAVIS CA
95616-4649
US

IV. Provider business mailing address

2008 MORSE AVE
SACRAMENTO CA
95825-2135
US

V. Phone/Fax

Practice location:
  • Phone: 530-204-8072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: