Healthcare Provider Details

I. General information

NPI: 1891711511
Provider Name (Legal Business Name): JOSEPH D ZICHI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4468 CROOKED OAK CT
JACKSONVILLE FL
32257-6482
US

IV. Provider business mailing address

4468 CROOKED OAK CT
JACKSONVILLE FL
32257-6482
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-6942
  • Fax: 904-268-4788
Mailing address:
  • Phone: 904-268-6942
  • Fax: 904-268-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: