Healthcare Provider Details

I. General information

NPI: 1508840752
Provider Name (Legal Business Name): RICHARD AVRAM ZUCKERWISE PHD, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21243 VENTURA BLVD SUITE 205
WOODLAND HILLS CA
91364-2123
US

IV. Provider business mailing address

21243 VENTURA BLVD SUITE 205
WOODLAND HILLS CA
91364-2123
US

V. Phone/Fax

Practice location:
  • Phone: 818-999-6452
  • Fax: 818-999-5912
Mailing address:
  • Phone: 818-999-6452
  • Fax: 818-999-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS 10021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: