Healthcare Provider Details

I. General information

NPI: 1750904983
Provider Name (Legal Business Name): JOANNA M ZACCARIA MS, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E GISH RD
SAN JOSE CA
95112-4706
US

IV. Provider business mailing address

601 ALMARIDA DR APT A02
CAMPBELL CA
95008-0215
US

V. Phone/Fax

Practice location:
  • Phone: 585-490-2565
  • Fax:
Mailing address:
  • Phone: 585-490-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12282
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: