Provider Demographics
NPI:1518984327
Name:J F ZAGOTTA & ASSOCIATES LLC
Entity Type:Organization
Organization Name:J F ZAGOTTA & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:ZAGOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:877-807-5120
Mailing Address - Street 1:8700 W BRYN MAWR AVE
Mailing Address - Street 2:SUITE 800 SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3512
Mailing Address - Country:US
Mailing Address - Phone:877-807-5120
Mailing Address - Fax:574-258-1898
Practice Address - Street 1:8700 W BRYN MAWR AVE
Practice Address - Street 2:SUITE 800 SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3512
Practice Address - Country:US
Practice Address - Phone:877-807-5120
Practice Address - Fax:574-258-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2002007508Medicaid
IN2002007508Medicaid