Provider Demographics
NPI:1225650732
Name:ZELDA MARIE VERRETT
Entity Type:Organization
Organization Name:ZELDA MARIE VERRETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAJUAN
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:VERRETT-EARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-533-4574
Mailing Address - Street 1:1003 E COOLEY DR STE 207
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3907
Mailing Address - Country:US
Mailing Address - Phone:909-533-4585
Mailing Address - Fax:909-533-4590
Practice Address - Street 1:1003 E COOLEY DR STE 207
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3907
Practice Address - Country:US
Practice Address - Phone:909-533-4585
Practice Address - Fax:909-533-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100143845Medicaid