Healthcare Provider Details

I. General information

NPI: 1801162664
Provider Name (Legal Business Name): MICHAEL C ZITO JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BLUE HILLS AVE 6TH FLOOR
HARTFORD CT
06112-1500
US

IV. Provider business mailing address

203 WILLIAMS ST E
GLASTONBURY CT
06033-2301
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-3700
  • Fax:
Mailing address:
  • Phone: 860-659-0309
  • Fax: 860-659-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001197
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: