Provider Demographics
NPI:1427436435
Name:ZAMMILLO, ELIZABETH MARIA
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:ZAMMILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:MARIA
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 HURTIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3816
Mailing Address - Country:US
Mailing Address - Phone:631-316-5782
Mailing Address - Fax:
Practice Address - Street 1:55 HURTIN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3816
Practice Address - Country:US
Practice Address - Phone:631-316-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst