MEDICARE: DAVID F ZITA PH.D.

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	103TC0700X	Clinical Psychologist	1085	CT

General Provider Information

NPI Number	:	1841295490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID F ZITA PH.D.

Provider Business Mailing Address
First Line	:	164 FOUR MILE RIVER RD
Second Line	:
City	:	OLD LYME
State	:	CT
Zip	:	06371-1325
Country	:	US
Telephone Number	:	860-434-8284
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 FOUR MILE RIVER RD
Second Line	:
City	:	OLD LYME
State	:	CT
Zip	:	06371-1325
Country	:	US
Telephone Number	:	860-434-8284
Fax Number	:

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

Provider Enumeration Date	:	06/19/2005
Last Update Date	:	07/09/2007

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Directions to “ DAVID F ZITA PH.D.” Practice Location

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