Healthcare Provider Details

I. General information

NPI: 1194917245
Provider Name (Legal Business Name): ROBERT ZACCHEO M.ED. L.M.H.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 COLORADO AVE SUITE6
STUART FL
34994-3031
US

IV. Provider business mailing address

PO BOX 265
STUART FL
34995-0265
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-3439
  • Fax: 772-220-3484
Mailing address:
  • Phone: 772-220-3439
  • Fax: 772-220-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: