Healthcare Provider Details
I. General information
NPI: 1427234491
Provider Name (Legal Business Name): MARC ZOLA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 01/21/2008
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
650 JOEL DR
FORT CAMPBELL KY
42223
US
IV. Provider business mailing address
320 OLD HICKORY BLVD APT 1707
NASHVILLE TN
37221-1311
US
V. Phone/Fax
- Phone: 270-412-5171
- Fax:
- Phone: 860-236-3834
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103G00000X |
| Taxonomy | Clinical Neuropsychologist |
| License Number | 1488 |
| License Number State | CT |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0700X |
| Taxonomy | Adult Development & Aging Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TB0200X |
| Taxonomy | Cognitive & Behavioral Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC2200X |
| Taxonomy | Clinical Child & Adolescent Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0000X |
| Taxonomy | Family Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0200X |
| Taxonomy | Forensic Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0004X |
| Taxonomy | Health Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0100X |
| Taxonomy | Health Service Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TM1800X |
| Taxonomy | Intellectual & Developmental Disabilities Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TP2701X |
| Taxonomy | Group Psychotherapy Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TR0400X |
| Taxonomy | Rehabilitation Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TS0200X |
| Taxonomy | School Psychologist |
| License Number | 1488 |
| License Number State | CT |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 1488 |
| License Number State | CT |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
