Healthcare Provider Details

I. General information

NPI: 1144383563
Provider Name (Legal Business Name): PHILIP ALAN ZUCKERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CLARK RD
ELDRED NY
12732-5012
US

IV. Provider business mailing address

45 CLARK RD
ELDRED NY
12732-5012
US

V. Phone/Fax

Practice location:
  • Phone: 845-741-8898
  • Fax:
Mailing address:
  • Phone: 845-557-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017984
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number049908-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: