Healthcare Provider Details

I. General information

NPI: 1518970920
Provider Name (Legal Business Name): JUDITH ZINN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 NORTH BROADWAY STE LE4
JERICHO NY
11753
US

IV. Provider business mailing address

116 LAUREL LANE
SYOSSET NY
11791
US

V. Phone/Fax

Practice location:
  • Phone: 516-932-5058
  • Fax:
Mailing address:
  • Phone: 516-367-9298
  • Fax: 516-367-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL016131
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: