Healthcare Provider Details

I. General information

NPI: 1952717829
Provider Name (Legal Business Name): JANET RIVKIN ZUCKERMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 MAMARONECK AVE SUITE 202
MAMARONECK NY
10543-1900
US

IV. Provider business mailing address

7 MARBOURNE DR
MAMARONECK NY
10543-1044
US

V. Phone/Fax

Practice location:
  • Phone: 914-777-1909
  • Fax:
Mailing address:
  • Phone: 914-777-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number012116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: