Healthcare Provider Details

I. General information

NPI: 1831595495
Provider Name (Legal Business Name): JENNIFER ZAPATA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 CAMINO DEL RIO S STE 407
SAN DIEGO CA
92108-4028
US

IV. Provider business mailing address

3517 CAMINO DEL RIO S STE 407
SAN DIEGO CA
92108-4028
US

V. Phone/Fax

Practice location:
  • Phone: 619-955-8905
  • Fax:
Mailing address:
  • Phone: 619-955-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberASW25678
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number72907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: