Healthcare Provider Details

I. General information

NPI: 1437228350
Provider Name (Legal Business Name): ANGELA LOUISE ZITO MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111-2410
US

IV. Provider business mailing address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111-2410
US

V. Phone/Fax

Practice location:
  • Phone: 314-481-1615
  • Fax: 314-353-1310
Mailing address:
  • Phone: 314-481-1615
  • Fax: 314-353-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2006008000
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: