Provider Demographics
NPI:1073755815
Name:ZAVRO, ANNETTE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:ZAVRO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4101
Mailing Address - Country:US
Mailing Address - Phone:904-824-7597
Mailing Address - Fax:904-824-7598
Practice Address - Street 1:165 SOUTHPARK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4101
Practice Address - Country:US
Practice Address - Phone:904-824-7597
Practice Address - Fax:904-824-7598
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH8243OtherFLORIDA MH LICENSE #