=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033155569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS J. ZIRPOLO PH. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2006
-----------------------------------------------------
Last Update Date | 11/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4161 EL CAMINO WAY SUITE B
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94306-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-494-1215
-----------------------------------------------------
Fax | 650-494-7272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4161 EL CAMINO WAY SUITE B
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94306-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-494-1215
-----------------------------------------------------
Fax | 650-494-7272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | PSY11597
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------