Healthcare Provider Details

I. General information

NPI: 1629341581
Provider Name (Legal Business Name): BRADLEY ZUCKER M.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NE 4TH ST
FORT LAUDERDALE FL
33301-1151
US

IV. Provider business mailing address

14041 SW 37TH CT
DAVIE FL
33330-1530
US

V. Phone/Fax

Practice location:
  • Phone: 954-453-6476
  • Fax: 954-764-6458
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: