Provider Demographics
NPI:1295276103
Name:GINA ZUCCOLO, PSY.D., P.A.
Entity type:Organization
Organization Name:GINA ZUCCOLO, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCCOLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-357-9612
Mailing Address - Street 1:601 N ASHLEY DR STE 11003002
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4334
Mailing Address - Country:US
Mailing Address - Phone:813-357-9612
Mailing Address - Fax:
Practice Address - Street 1:601 N ASHLEY DR STE 11003002
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4334
Practice Address - Country:US
Practice Address - Phone:813-357-9612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9735103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty