Healthcare Provider Details

I. General information

NPI: 1588326938
Provider Name (Legal Business Name): ZACHARY ZICKGRAF LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 CAMPUS DR STE A245
IRVINE CA
92612-8630
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 949-502-0736
  • Fax:
Mailing address:
  • Phone: 916-576-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: