Jaclyn Zeccola, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSB37634 Issued in CA

Practice address

11712 Moorpark St Ste 204B
Studio City, CA 91604-2158

Phone

(323) 636-1632

NPI assigned

Dec 14, 2016

Last updated

Jun 18, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1093259715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11712 MOORPARK ST STE 204B",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916042158",
            "telephone_number": "323-636-1632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11712 MOORPARK ST STE 204B",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916042158",
            "telephone_number": "323-636-1632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "595 E Colorado Blvd",
            "address_2": "706",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911012039",
            "country_code": "US",
            "telephone_number": "323-636-1632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZECCOLA",
        "first_name": "JACLYN",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-14",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSB37634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Studio City, CA
• Providers in Studio City, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.