Healthcare Provider Details

I. General information

NPI: 1073135810
Provider Name (Legal Business Name): CHRISTA ZUMMO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 5TH AVE RM 906
NEW YORK NY
10016-6588
US

IV. Provider business mailing address

1153 ELLSWORTH AVE FL 2
BRONX NY
10465-1424
US

V. Phone/Fax

Practice location:
  • Phone: 347-815-3142
  • Fax:
Mailing address:
  • Phone: 347-503-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: