Provider Demographics
NPI:1861647190
Name:ZODA, LILLIAN J (RN)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:J
Last Name:ZODA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 44TH CT E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-2206
Mailing Address - Country:US
Mailing Address - Phone:914-466-1816
Mailing Address - Fax:
Practice Address - Street 1:1000 118TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2332
Practice Address - Country:US
Practice Address - Phone:888-366-6243
Practice Address - Fax:866-907-4842
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC212391101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor