Healthcare Provider Details

I. General information

NPI: 1558758532
Provider Name (Legal Business Name): PAUL ZOTT LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

23368 HAZELWOOD AVE
HAZEL PARK MI
48030-2716
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7701
  • Fax:
Mailing address:
  • Phone: 586-484-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801096986
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: