Healthcare Provider Details

I. General information

NPI: 1083505549
Provider Name (Legal Business Name): LACEY ZUCCALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 CORAL DR
BOYNTON BEACH FL
33426-3521
US

IV. Provider business mailing address

1040 CORAL DR
BOYNTON BEACH FL
33426-3521
US

V. Phone/Fax

Practice location:
  • Phone: 561-352-7056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: