Provider Demographics
NPI:1073725099
Name:LISA ZOCCO P C
Entity Type:Organization
Organization Name:LISA ZOCCO P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-466-7300
Mailing Address - Street 1:6160 KEMPSVILLE CIR
Mailing Address - Street 2:SUITE 327A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3933
Mailing Address - Country:US
Mailing Address - Phone:757-466-7300
Mailing Address - Fax:
Practice Address - Street 1:6160 KEMPSVILLE CIR
Practice Address - Street 2:SUITE 327A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3933
Practice Address - Country:US
Practice Address - Phone:757-466-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001281103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007702752Medicaid
VA309759OtherBC/BS