Healthcare Provider Details

I. General information

NPI: 1033692637
Provider Name (Legal Business Name): JARED ROSS ZIPPER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 CONGRESS AVE STE 160
BOCA RATON FL
33487-2861
US

IV. Provider business mailing address

5030 CHAMPION BLVD STE G11-535
BOCA RATON FL
33496-2473
US

V. Phone/Fax

Practice location:
  • Phone: 561-464-5500
  • Fax: 561-464-5501
Mailing address:
  • Phone: 561-464-5500
  • Fax: 561-464-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberSW17668
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: