Healthcare Provider Details

I. General information

NPI: 1174712129
Provider Name (Legal Business Name): MARY ZAMBITO LPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 RTE. 202 SUITE 8
FAR HILLS NJ
07931
US

IV. Provider business mailing address

5 LYONS MALL # 110
BASKING RIDGE NJ
07920-1928
US

V. Phone/Fax

Practice location:
  • Phone: 908-766-6208
  • Fax:
Mailing address:
  • Phone: 908-766-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00150600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00324300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: