Healthcare Provider Details

I. General information

NPI: 1437177763
Provider Name (Legal Business Name): RICHARD M ZUCKERBERG PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 CARROLL ST
BROOKLYN NY
11215-2102
US

IV. Provider business mailing address

721 PRESIDENT ST APT 2
BROOKLYN NY
11215-1207
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-8278
  • Fax:
Mailing address:
  • Phone: 718-636-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: