MEDICARE: DR. GEORGE ZAKY PSY.D., LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH9083	FL
2	103G00000X	Clinical Neuropsychologist	PY8016	FL
3	103T00000X	Psychologist	PY8016	FL
4	103TB0200X	Cognitive & Behavioral Psychologist	PY8016	FL
5	103TC0700X	Clinical Psychologist	PY8016	FL
6	103TF0200X	Forensic Psychologist	PY8016	FL

General Provider Information

NPI Number	:	1194949495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE ZAKY PSY.D., LMHC

Provider Business Mailing Address
First Line	:	447 NW PRIMA VISTA BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-8731
Country	:	US
Telephone Number	:	772-249-2593
Fax Number	:

Provider Business Practice Location Address
First Line	:	447 NW PRIMA VISTA BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-8731
Country	:	US
Telephone Number	:	772-249-2593
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	03/17/2018

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