Healthcare Provider Details

I. General information

NPI: 1801785951
Provider Name (Legal Business Name): MADISON ZUCKERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1099
US

IV. Provider business mailing address

1493 CAMBRIDGE ST. MACHT 508
CAMBRIDGE MA
02139
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2140725
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: