Healthcare Provider Details

I. General information

NPI: 1235007378
Provider Name (Legal Business Name): DANA ZICCARELLO SAP, ICADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SUNRISE DR
WHIPPANY NJ
07981-1164
US

IV. Provider business mailing address

109 SUNRISE DR
WHIPPANY NJ
07981-1164
US

V. Phone/Fax

Practice location:
  • Phone: 908-656-2884
  • Fax:
Mailing address:
  • Phone: 908-656-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00126700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: