Healthcare Provider Details

I. General information

NPI: 1679112015
Provider Name (Legal Business Name): MARY ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E BROAD ST
COLUMBUS OH
43215-4004
US

IV. Provider business mailing address

431 E BROAD ST
COLUMBUS OH
43215-4004
US

V. Phone/Fax

Practice location:
  • Phone: 740-428-0428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1901216-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2005510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: