Provider Demographics
NPI:1306567912
Name:ZOTTARELLI, ROD MICHAEL (LMFT)
Entity type:Individual
Prefix:
First Name:ROD
Middle Name:MICHAEL
Last Name:ZOTTARELLI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3789 CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-9410
Mailing Address - Country:US
Mailing Address - Phone:610-703-5090
Mailing Address - Fax:
Practice Address - Street 1:6735 CETRONIA RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9202
Practice Address - Country:US
Practice Address - Phone:610-703-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist