Healthcare Provider Details

I. General information

NPI: 1730623422
Provider Name (Legal Business Name): CATHERINE ZYDLEWSKI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 RAINTREE RD STE 200A
CHESAPEAKE VA
23321-3757
US

IV. Provider business mailing address

4016 RAINTREE RD STE 200A
CHESAPEAKE VA
23321-3757
US

V. Phone/Fax

Practice location:
  • Phone: 757-465-3933
  • Fax: 757-465-3944
Mailing address:
  • Phone: 757-465-3933
  • Fax: 757-465-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MICHELE RIVETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-465-3933