Provider Demographics
NPI:1588997985
Name:ZACCANELLI, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ZACCANELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7646
Mailing Address - Country:US
Mailing Address - Phone:804-365-4226
Mailing Address - Fax:804-365-4252
Practice Address - Street 1:12300 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7646
Practice Address - Country:US
Practice Address - Phone:804-365-4226
Practice Address - Fax:804-365-4252
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid