Healthcare Provider Details

I. General information

NPI: 1679046031
Provider Name (Legal Business Name): DIANA MARIE ZINNIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BLACKHORSE HILL ROAD
COATESVILLE PA
19320
US

IV. Provider business mailing address

1516 JOHNNY'S WAY
WEST CHESTER PA
19382
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-7711
  • Fax: 610-383-0264
Mailing address:
  • Phone: 484-686-0711
  • Fax: 610-383-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016721
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: