Provider Demographics
NPI:1356158273
Name:ZUMMO, KELLY (PPS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ZUMMO
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7471 LARKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1500
Mailing Address - Country:US
Mailing Address - Phone:925-828-2551
Mailing Address - Fax:
Practice Address - Street 1:7471 LARKDALE AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-1500
Practice Address - Country:US
Practice Address - Phone:925-828-2551
Practice Address - Fax:925-803-1669
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230191056101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool