Healthcare Provider Details

I. General information

NPI: 1447338363
Provider Name (Legal Business Name): MIRIAM SARAH ZICHT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36362 US HIGHWAY 19 N SEIN PROFESSIONAL CENTER
PALM HARBOR FL
34684-1328
US

IV. Provider business mailing address

36362 US HIGHWAY 19 NORTH SEIN PROFESSIONAL CENTER
PALM HARBOR FL
34684
US

V. Phone/Fax

Practice location:
  • Phone: 727-787-6177
  • Fax: 727-787-8066
Mailing address:
  • Phone: 727-787-6177
  • Fax: 727-787-8066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: