Healthcare Provider Details

I. General information

NPI: 1013042902
Provider Name (Legal Business Name): PETER J ZUCKER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES WAY SUITE 150
LONG BEACH CA
90810-1876
US

IV. Provider business mailing address

640 27TH ST
MANHATTAN BEACH CA
90266-2231
US

V. Phone/Fax

Practice location:
  • Phone: 310-221-6336
  • Fax:
Mailing address:
  • Phone: 310-796-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9177
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number19870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: