Provider Demographics
NPI:1558383422
Name:ZOLLO, LINDA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:ZOLLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3011
Mailing Address - Country:US
Mailing Address - Phone:603-724-4140
Mailing Address - Fax:
Practice Address - Street 1:753 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3011
Practice Address - Country:US
Practice Address - Phone:603-724-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH499103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE0670Medicare ID - Type Unspecified
NH30004195Medicaid