Healthcare Provider Details

I. General information

NPI: 1487795522
Provider Name (Legal Business Name): DEANNE U. ZOTTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEANNE ZOTTER BONIFAZI PH.D.

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CHRISTY DR SUITE 102
CHADDS FORD PA
19317-9682
US

IV. Provider business mailing address

291 DRESSAGE CT
WEST CHESTER PA
19382-2365
US

V. Phone/Fax

Practice location:
  • Phone: 484-947-3268
  • Fax:
Mailing address:
  • Phone: 484-947-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007150L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS007150L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: