Healthcare Provider Details

I. General information

NPI: 1417431313
Provider Name (Legal Business Name): JULIANA ROSE ZUCCARELLI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 GATEWAY BLVD STE C
MOORESVILLE NC
28117-5544
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-3637
  • Fax: 704-323-5710
Mailing address:
  • Phone: 704-360-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC017686
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: