MEDICARE: MRS. SUSAN ZUCKERMAN-MORELL L.C. S.W.

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	1041C0700X	Clinical Social Worker	PR020307-1	NY

General Provider Information

NPI Number	:	1679533996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN ZUCKERMAN-MORELL L.C. S.W.

Provider Business Mailing Address
First Line	:	469 10TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4301
Country	:	US
Telephone Number	:	718-832-4665
Fax Number	:	718-369-8901

Provider Business Practice Location Address
First Line	:	469 10TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4301
Country	:	US
Telephone Number	:	718-832-4665
Fax Number	:	718-369-8901

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	03/18/2009

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