Healthcare Provider Details

I. General information

NPI: 1790185908
Provider Name (Legal Business Name): JENNA ZUCCHI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST # VC-4
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST # VC-4
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-7259
  • Fax:
Mailing address:
  • Phone: 718-231-3400
  • Fax: 718-655-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number022046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: