Healthcare Provider Details

I. General information

NPI: 1154378123
Provider Name (Legal Business Name): UMA KUCHIBHOTLA ZYKOFSKY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001A EAST PKWY SUITE 300
SACRAMENTO CA
95823-2501
US

IV. Provider business mailing address

7001A EAST PKWY SUITE 300
SACRAMENTO CA
95823-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-3321
  • Fax: 916-875-0877
Mailing address:
  • Phone: 916-875-3321
  • Fax: 916-875-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS17576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: