Healthcare Provider Details

I. General information

NPI: 1841485836
Provider Name (Legal Business Name): MARC TODD ZUCKER PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 W SAHARA AVE STE 110
LAS VEGAS NV
89117-8804
US

IV. Provider business mailing address

9510 W SAHARA AVE STE 110
LAS VEGAS NV
89117-8804
US

V. Phone/Fax

Practice location:
  • Phone: 702-641-2422
  • Fax: 702-893-9655
Mailing address:
  • Phone: 702-641-2422
  • Fax: 702-893-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0530
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0530
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: