Healthcare Provider Details

I. General information

NPI: 1356968317
Provider Name (Legal Business Name): HEATHER ANNE ZUCKERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LOWER STATION RD
GARRISON NY
10524-3604
US

IV. Provider business mailing address

PO BOX 403
GARRISON NY
10524-0403
US

V. Phone/Fax

Practice location:
  • Phone: 646-351-3702
  • Fax:
Mailing address:
  • Phone: 646-351-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089552-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: