Healthcare Provider Details

I. General information

NPI: 1306567912
Provider Name (Legal Business Name): ROD MICHAEL ZOTTARELLI LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 CETRONIA RD
ALLENTOWN PA
18106-9202
US

IV. Provider business mailing address

3789 CLOVER DR
CENTER VALLEY PA
18034-9410
US

V. Phone/Fax

Practice location:
  • Phone: 610-703-5090
  • Fax:
Mailing address:
  • Phone: 610-703-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001423
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: