Healthcare Provider Details

I. General information

NPI: 1932232667
Provider Name (Legal Business Name): GRACE ANN NEBRES-ZUCKERMAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W PADONIA RD SUITE C-353
TIMONIUM MD
21093-2226
US

IV. Provider business mailing address

22 W PADONIA RD SUITE C-353
TIMONIUM MD
21093-2226
US

V. Phone/Fax

Practice location:
  • Phone: 240-354-3815
  • Fax:
Mailing address:
  • Phone: 240-354-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12983
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: