Healthcare Provider Details

I. General information

NPI: 1033281092
Provider Name (Legal Business Name): KELLY ANN ZUCCO L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 HIGH ST
WAREHAM MA
02571-2052
US

IV. Provider business mailing address

9 MELISSA ANN LN
MATTAPOISETT MA
02739-1078
US

V. Phone/Fax

Practice location:
  • Phone: 508-295-2699
  • Fax:
Mailing address:
  • Phone: 508-758-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW # 110331
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: