Healthcare Provider Details

I. General information

NPI: 1669623864
Provider Name (Legal Business Name): ANGELA ZIZZAMIA PHD, LMHC, CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PINE GROVE ST
WOODSTOCK NY
12498-1507
US

IV. Provider business mailing address

15 PINE GROVE ST
WOODSTOCK NY
12498-1507
US

V. Phone/Fax

Practice location:
  • Phone: 845-679-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000062
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1050608
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number018565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: