Healthcare Provider Details

I. General information

NPI: 1609480839
Provider Name (Legal Business Name): OMAR ZOOK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W CHOCOLATE AVE FL 2
HERSHEY PA
17033-1663
US

IV. Provider business mailing address

527 W CHOCOLATE AVE FL 2
HERSHEY PA
17033-1663
US

V. Phone/Fax

Practice location:
  • Phone: 717-875-6087
  • Fax: 570-915-5355
Mailing address:
  • Phone: 717-875-6087
  • Fax: 570-915-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW-000643-L
License Number StatePA

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: