Healthcare Provider Details

I. General information

NPI: 1265798441
Provider Name (Legal Business Name): ROBERTA LYNN ZUCKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CLAY ST 1ST FLOOR
SAN FRANCISCO CA
94115-1931
US

IV. Provider business mailing address

2351 CLAY ST 1ST FLOOR
SAN FRANCISCO CA
94115-1931
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-3604
  • Fax: 916-854-6844
Mailing address:
  • Phone: 415-600-3604
  • Fax: 916-854-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS10751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: