Healthcare Provider Details

I. General information

NPI: 1245951839
Provider Name (Legal Business Name): COURTNEY ZUCKER ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 ZANKER RD
SAN JOSE CA
95134-2130
US

IV. Provider business mailing address

58 CALLIE LN
MENLO PARK CA
94025-1701
US

V. Phone/Fax

Practice location:
  • Phone: 650-472-7022
  • Fax:
Mailing address:
  • Phone: 650-472-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: