Healthcare Provider Details

I. General information

NPI: 1366542979
Provider Name (Legal Business Name): ANTHONY S. ZAZA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 KIRKWOOD HWY SUITE 1143
WILMINGTON DE
19805-4917
US

IV. Provider business mailing address

1601 KIRKWOOD HWY SUITE 1143
WILMINGTON DE
19805-4917
US

V. Phone/Fax

Practice location:
  • Phone: 302-633-5225
  • Fax: 302-633-5428
Mailing address:
  • Phone: 302-633-5225
  • Fax: 302-633-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberB10000205
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: