Healthcare Provider Details

I. General information

NPI: 1811570898
Provider Name (Legal Business Name): VICTORIA ZAPPAVIGNA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14933 FOUNDERS XING
HOMER GLEN IL
60491-6712
US

IV. Provider business mailing address

110 BAYBURY DR
ELWOOD IL
60421-6068
US

V. Phone/Fax

Practice location:
  • Phone: 708-737-7968
  • Fax:
Mailing address:
  • Phone: 906-250-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021726
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: