Healthcare Provider Details

I. General information

NPI: 1629313820
Provider Name (Legal Business Name): MAYER ZUCKERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 RIVER AVE SUITE 2B
LAKEWOOD NJ
08701-5229
US

IV. Provider business mailing address

681 RIVER AVE SUITE 2B
LAKEWOOD NJ
08701-5229
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-0300
  • Fax:
Mailing address:
  • Phone: 732-367-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05423400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: