Healthcare Provider Details

I. General information

NPI: 1902430804
Provider Name (Legal Business Name): BRIGITTE ZYLAROCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 CHAPEL HILL RD STE A
RALEIGH NC
27607-5043
US

IV. Provider business mailing address

1105 TRYON VILLAGE DR STE 303 #1046
RALEIGH NC
27518-7170
US

V. Phone/Fax

Practice location:
  • Phone: 984-664-3203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109011-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015612
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: