Healthcare Provider Details

I. General information

NPI: 1467621169
Provider Name (Legal Business Name): MICHELLE SHERRI ZUCKERMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 BOULEVARD
KENILWORTH NJ
07033-1603
US

IV. Provider business mailing address

288 MAIN ST APT G
MADISON NJ
07940-2346
US

V. Phone/Fax

Practice location:
  • Phone: 973-420-9705
  • Fax:
Mailing address:
  • Phone: 973-420-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4485
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: