Provider Demographics
NPI:1841875630
Name:ZAYAS, CHARISSA DANIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:DANIELLE
Last Name:ZAYAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 BAYSIDE LAKES BLVD SE ST 103
Mailing Address - Street 2:PMB 1177
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-3882
Mailing Address - Country:US
Mailing Address - Phone:321-209-2005
Mailing Address - Fax:
Practice Address - Street 1:3425 BAYSIDE LAKES BLVD SE ST 103
Practice Address - Street 2:PMB 1177
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-3882
Practice Address - Country:US
Practice Address - Phone:321-209-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW183431041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty