MEDICARE: MS. UMA KUCHIBHOTLA ZYKOFSKY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LCS17576	CA

General Provider Information

NPI Number	:	1154378123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. UMA KUCHIBHOTLA ZYKOFSKY LCSW

Provider Business Mailing Address
First Line	:	7001A EAST PKWY
Second Line	:	SUITE 300
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2501
Country	:	US
Telephone Number	:	916-875-3321
Fax Number	:	916-875-0877

Provider Business Practice Location Address
First Line	:	7001A EAST PKWY
Second Line	:	SUITE 300
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2501
Country	:	US
Telephone Number	:	916-875-3321
Fax Number	:	916-875-0877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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