Healthcare Provider Details

I. General information

NPI: 1568152163
Provider Name (Legal Business Name): PAUL ZUKAS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7635 ASHLEY PARK CT STE 503H
ORLANDO FL
32835-6197
US

IV. Provider business mailing address

7635 ASHLEY PARK CT STE 503H
ORLANDO FL
32835-6197
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4265
  • Fax: 407-215-9436
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: