Connie D Zollner, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

2370 130TH Ave NE Ste 104
Bellevue, WA 98005-1770

Phone

(425) 628-2820

NPI assigned

Jan 25, 2021

Last updated

Jan 25, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Betrayal Trauma Recovery Center

  • Mental Health Counselor
  • Bellevue, WA
  • NPI 1487353785
  NPD (past) Authorized official
• Pacific Behavioral Healthcare

  • Mental Health Counselor
  • Bellevue, WA
  • NPI 1932529120
  NPD (past)

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

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1275123093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2370 130TH AVE NE STE 104",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980051770",
            "telephone_number": "425-628-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2370 130TH AVE NE STE 104",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980051770",
            "telephone_number": "425-628-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZOLLNER",
        "first_name": "CONNIE",
        "middle_name": "D",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harold L Zimmer, M.D.
• Crystal Anne Ziniewicz, PHARMD
• Adam H Zivin, M.D.
• Kiara Danielle Zmiarovich Sadaya, CBT
• Ara Zohrabian, CHIROPRACTOR
• Zoomcare Urgent Care LLC (ZoomCare - Bellevue Super)
• Fanyun Zou
• Kaisera Jamil Zubair, M.D.
• Mudasir Zubair
• Hannah Zundel

• Psychologist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.