Healthcare Provider Details

I. General information

NPI: 1801105259
Provider Name (Legal Business Name): NANCY ZUCCANI MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 EL CAMINO REAL SUITE 2
SAN BRUNO CA
94066
US

IV. Provider business mailing address

375 MOUNTAIN HOME ROAD
WOODSIDE CA
94062-2569
US

V. Phone/Fax

Practice location:
  • Phone: 650-868-5158
  • Fax: 650-851-5474
Mailing address:
  • Phone: 650-851-5474
  • Fax: 650-851-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC18690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: