Healthcare Provider Details

I. General information

NPI: 1710413844
Provider Name (Legal Business Name): KAYLA BETH ZUCKER M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 NW 167TH ST
MIAMI GARDENS FL
33056
US

IV. Provider business mailing address

1825 NW 167TH ST
MIAMI GARDENS FL
33056
US

V. Phone/Fax

Practice location:
  • Phone: 305-624-6716
  • Fax:
Mailing address:
  • Phone: 305-624-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: