Healthcare Provider Details

I. General information

NPI: 1942581582
Provider Name (Legal Business Name): ZINNA & AMADO PSYCHOLOGICAL CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PROFESSIONAL DR SUITE 120
GAITHERSBURG MD
20879-3407
US

IV. Provider business mailing address

4 PROFESSIONAL DR SUITE 120
GAITHERSBURG MD
20879-3407
US

V. Phone/Fax

Practice location:
  • Phone: 202-355-5300
  • Fax:
Mailing address:
  • Phone: 202-355-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04538
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number04538
License Number StateMD

VIII. Authorized Official

Name: DR. ALFRED JOSEPH AMADO
Title or Position: VICE-PRESIDENT
Credential: PHD
Phone: 301-355-3500