Healthcare Provider Details

I. General information

NPI: 1710196613
Provider Name (Legal Business Name): BARBARA I ZUCAL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15152 TRUMAN MANOR LN
WALDORF MD
20601-4467
US

IV. Provider business mailing address

15152 TRUMAN MANOR LN
WALDORF MD
20601-4467
US

V. Phone/Fax

Practice location:
  • Phone: 301-274-3898
  • Fax: 301-274-3867
Mailing address:
  • Phone: 301-274-3898
  • Fax: 301-274-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM049
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: