Healthcare Provider Details

I. General information

NPI: 1679533996
Provider Name (Legal Business Name): SUSAN ZUCKERMAN-MORELL L.C. S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN ZUCKERMAN MORELL L.C.S.W.

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 10TH ST
BROOKLYN NY
11215-4301
US

IV. Provider business mailing address

469 10TH ST
BROOKLYN NY
11215-4301
US

V. Phone/Fax

Practice location:
  • Phone: 718-832-4665
  • Fax: 718-369-8901
Mailing address:
  • Phone: 718-832-4665
  • Fax: 718-369-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR020307-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: