Healthcare Provider Details

I. General information

NPI: 1851922868
Provider Name (Legal Business Name): LEE ZUCKERMAN SHARE PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 CENTRAL PARK W APT 1A
NEW YORK NY
10024-4111
US

IV. Provider business mailing address

650 W END AVE APT 7A
NEW YORK NY
10025-7355
US

V. Phone/Fax

Practice location:
  • Phone: 917-312-1386
  • Fax:
Mailing address:
  • Phone: 917-312-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number001057-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: