Healthcare Provider Details

I. General information

NPI: 1558065763
Provider Name (Legal Business Name): ANGEL ZAPATA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 CALM WATER WAY
SUMMERVILLE SC
29486-6942
US

IV. Provider business mailing address

174 CALM WATER WAY
SUMMERVILLE SC
29486-6942
US

V. Phone/Fax

Practice location:
  • Phone: 347-806-6312
  • Fax:
Mailing address:
  • Phone: 347-806-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15881
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: