Healthcare Provider Details

I. General information

NPI: 1407692155
Provider Name (Legal Business Name): MARY ZOTTOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 594
SOMERS NY
10589-0594
US

IV. Provider business mailing address

PO BOX 594
SOMERS NY
10589-0594
US

V. Phone/Fax

Practice location:
  • Phone: 914-222-0431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: