Healthcare Provider Details

I. General information

NPI: 1598716128
Provider Name (Legal Business Name): BETH L ZUKOWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE SUITE 309
FARMINGTON CT
06032-1909
US

IV. Provider business mailing address

150 SCHNOOR RD
KILLINGWORTH CT
06419-1113
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-5570
  • Fax: 860-677-9570
Mailing address:
  • Phone: 860-685-1701
  • Fax: 860-663-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005595
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: