Provider Demographics
NPI:1609643519
Name:ZAMMUTO, PETER ANGELO (PSYD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANGELO
Last Name:ZAMMUTO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E GRAND AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3800
Mailing Address - Country:US
Mailing Address - Phone:847-686-0090
Mailing Address - Fax:
Practice Address - Street 1:160 E GRAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3800
Practice Address - Country:US
Practice Address - Phone:847-686-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent