Healthcare Provider Details

I. General information

NPI: 1255036679
Provider Name (Legal Business Name): ROBERT M ZIPPERER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 WREN AVENUE
LEESBURG FL
34748
US

IV. Provider business mailing address

1313 WREN AVENUE
LEESBURG FL
34748
US

V. Phone/Fax

Practice location:
  • Phone: 352-551-8425
  • Fax:
Mailing address:
  • Phone: 352-551-8425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW3374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: