Healthcare Provider Details

I. General information

NPI: 1679122303
Provider Name (Legal Business Name): TEDDI ZUCKERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
NASHUA NH
03064-2716
US

IV. Provider business mailing address

1 MAIN ST
NASHUA NH
03064-2716
US

V. Phone/Fax

Practice location:
  • Phone: 603-689-7978
  • Fax: 603-883-0007
Mailing address:
  • Phone: 603-689-7978
  • Fax: 603-883-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1459
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: