Provider Demographics
NPI:1063516094
Name:ZAMMITT, CLARISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:
Last Name:ZAMMITT
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:PO BOX 994581
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4581
Mailing Address - Country:US
Mailing Address - Phone:530-221-8806
Mailing Address - Fax:530-221-8807
Practice Address - Street 1:1133 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2113
Practice Address - Country:US
Practice Address - Phone:530-221-8806
Practice Address - Fax:530-221-8807
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL 190710Medicare ID - Type Unspecified