Healthcare Provider Details

I. General information

NPI: 1073151791
Provider Name (Legal Business Name): JENNIFER ZITO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FOUNDERS BRIDGE BLVD
MIDLOTHIAN VA
23113-6309
US

IV. Provider business mailing address

1900 E CARY ST APT 309A
RICHMOND VA
23223-6991
US

V. Phone/Fax

Practice location:
  • Phone: 804-210-5448
  • Fax:
Mailing address:
  • Phone: 804-400-9253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011346
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: