Healthcare Provider Details

I. General information

NPI: 1568544484
Provider Name (Legal Business Name): JACKIE LYNN ZUCKERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3187 ANN ST
BALDWIN NY
11510-4509
US

IV. Provider business mailing address

3187 ANN ST
BALDWIN NY
11510-4509
US

V. Phone/Fax

Practice location:
  • Phone: 516-236-9111
  • Fax: 516-223-0332
Mailing address:
  • Phone: 516-236-9111
  • Fax: 516-223-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR031960-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: