Healthcare Provider Details

I. General information

NPI: 1972508471
Provider Name (Legal Business Name): MATTHEW PAUL ZICCARDI PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST NE
BARBERTON OH
44203-3332
US

IV. Provider business mailing address

1325 PATTON CT
TWINSBURG OH
44087-1014
US

V. Phone/Fax

Practice location:
  • Phone: 330-615-3900
  • Fax: 330-615-3909
Mailing address:
  • Phone: 330-486-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number5281
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: