Healthcare Provider Details

I. General information

NPI: 1760638985
Provider Name (Legal Business Name): VANESSA PARRY ZOOG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E BROAD ST
PALMYRA NJ
08065-1607
US

IV. Provider business mailing address

303 E BROAD ST
PALMYRA NJ
08065-1607
US

V. Phone/Fax

Practice location:
  • Phone: 856-499-2013
  • Fax: 856-499-2016
Mailing address:
  • Phone: 856-499-2013
  • Fax: 856-499-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05357000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: