Provider Demographics
NPI:1932300092
Name:ZELLLICK, SANDRA Z (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:Z
Last Name:ZELLLICK
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 1:1019 COVERT RD.
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-6377
Mailing Address - Country:US
Mailing Address - Phone:941-492-5555
Mailing Address - Fax:
Practice Address - Street 1:1019 COVERT RD.
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-6377
Practice Address - Country:US
Practice Address - Phone:941-492-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0002987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health