Individual provider Active NPI

Rose Zayco, PSY.D.

  • Clinical Psychologist
  • Jacksonville, FL
National Provider Identifier
1649585720
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY 8136 Issued in FL
Practice address
2523 Herschel St
Jacksonville, FL 32204
Phone
(904) 351-8136
Fax
(888) 972-6788
NPI assigned
Aug 12, 2010
Last updated
Jan 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY 8136 FL Primary

Addresses

Primary practice location

2523 Herschel St
Jacksonville, FL 32204

Mailing address

2523 Herschel St
Jacksonville, FL 32204-4509
Phone (904) 351-8136

Other practice location 1

4210 Valley Ridge Blvd Ste 145
Ponte Vedra, FL 32081-5184
Phone (904) 351-8136

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101025001356 FL Practitioner - Clinical Psychologist 6305039199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2523 Herschel St
Jacksonville, FL 32204-4509
Phone (904) 351-8136

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PY 8136FLMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Rose Zayco, Psy.D. Inc. Clinical CurrentSince Aug 16, 2010 Accepting new patients

Locations

2523 Herschel St
Jacksonville, FL 32204
Phone (786) 868-7017

4210 Valley Ridge Blvd
Ste 145
Ponte Vedra, FL 32081
Phone (904) 351-8136

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1649585720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2523 HERSCHEL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044509",
            "telephone_number": "904-351-8136",
            "fax_number": "888-972-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2523 HERSCHEL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32204",
            "telephone_number": "904-351-8136",
            "fax_number": "888-972-6788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4210 Valley Ridge Blvd Ste 145",
            "address_purpose": "LOCATION",
            "city": "Ponte Vedra",
            "state": "FL",
            "postal_code": "320815184",
            "country_code": "US",
            "telephone_number": "904-351-8136",
            "fax_number": "888-972-6788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZAYCO",
        "first_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-12",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 8136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.