MEDICARE: CHARISSA DANIELLE ZAYAS LCSW

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	1041C0700X	Clinical Social Worker	SW18343	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841875630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSA DANIELLE ZAYAS LCSW

Provider Business Mailing Address
First Line	:	3425 BAYSIDE LAKES BLVD SE ST 103
Second Line	:	PMB 1177
City	:	PALM BAY
State	:	FL
Zip	:	32909-3882
Country	:	US
Telephone Number	:	321-209-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 BAYSIDE LAKES BLVD SE ST 103
Second Line	:	PMB 1177
City	:	PALM BAY
State	:	FL
Zip	:	32909-3882
Country	:	US
Telephone Number	:	321-209-2005
Fax Number	:

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

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	10/11/2023

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