Healthcare Provider Details

I. General information

NPI: 1982911780
Provider Name (Legal Business Name): ROSE ZAYCO, PSY.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 HERSCHEL ST
JACKSONVILLE FL
32204
US

IV. Provider business mailing address

2523 HERSCHEL ST
JACKSONVILLE FL
32204-4509
US

V. Phone/Fax

Practice location:
  • Phone: 904-351-8136
  • Fax: 888-972-6788
Mailing address:
  • Phone: 904-351-8136
  • Fax: 888-972-6788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 8136
License Number StateFL

VIII. Authorized Official

Name: DR. ROSE ZAYCO
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 904-351-8136