Healthcare Provider Details

I. General information

NPI: 1639896525
Provider Name (Legal Business Name): KERRI ERIN ZAPPALA-PIEMME PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRI ZAPPALA PH.D.

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WHITE HORSE RANCH 2021 STATE ROUTE 28
WEVERTOWN NY
12886
US

IV. Provider business mailing address

PO BOX 55
WEVERTOWN NY
12886-0055
US

V. Phone/Fax

Practice location:
  • Phone: 518-538-4696
  • Fax:
Mailing address:
  • Phone: 518-538-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number020995
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number020995
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: