Healthcare Provider Details

I. General information

NPI: 1942522446
Provider Name (Legal Business Name): AMY ZUCKERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 FENWAY
ROCKVILLE CENTRE NY
11570-4504
US

IV. Provider business mailing address

59 FENWAY
ROCKVILLE CENTRE NY
11570-4504
US

V. Phone/Fax

Practice location:
  • Phone: 212-496-2351
  • Fax:
Mailing address:
  • Phone: 212-496-2351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR027382-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: