Healthcare Provider Details

I. General information

NPI: 1932268489
Provider Name (Legal Business Name): ELIZABETH BERMAN ZUCH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LEFURGY AVE HILLSIDE ELEMENTARY SCHOOL
HASTINGS ON HUDSON NY
10706
US

IV. Provider business mailing address

46 MANSFIELD RD
WHITE PLAINS NY
10605-4428
US

V. Phone/Fax

Practice location:
  • Phone: 914-478-6282
  • Fax:
Mailing address:
  • Phone: 914-948-1183
  • Fax: 914-428-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number010119
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number010119-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number010119-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: