Healthcare Provider Details

I. General information

NPI: 1720132137
Provider Name (Legal Business Name): SCOTT VANDER ZEE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E ESPLANADE DR 1140
OXNARD CA
93036-2110
US

IV. Provider business mailing address

500 E ESPLANADE DR 1140
OXNARD CA
93036-2110
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-1031
  • Fax: 805-988-8441
Mailing address:
  • Phone: 805-988-1031
  • Fax: 805-988-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW4292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: