Provider Demographics
NPI:1366713505
Name:ZUCCARINO, ANGELA N (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:N
Last Name:ZUCCARINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 670
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2401
Mailing Address - Country:US
Mailing Address - Phone:213-384-7660
Mailing Address - Fax:213-384-2084
Practice Address - Street 1:3550 WILSHIRE BLVD
Practice Address - Street 2:SUITE 670
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2401
Practice Address - Country:US
Practice Address - Phone:213-384-7660
Practice Address - Fax:213-384-2084
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist