Healthcare Provider Details

I. General information

NPI: 1295982254
Provider Name (Legal Business Name): TERRI LYN ZUCKER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 3RD AVE STE 208
SAN MATEO CA
94401-4051
US

IV. Provider business mailing address

13 12TH AVE
SAN MATEO CA
94402-2401
US

V. Phone/Fax

Practice location:
  • Phone: 650-759-2475
  • Fax: 650-571-0747
Mailing address:
  • Phone: 650-759-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25497
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: