Healthcare Provider Details

I. General information

NPI: 1780492025
Provider Name (Legal Business Name): MICHAEL THOMAS ZUCH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 EASTLAND AVE UNIT 101
NASHVILLE TN
37206-1705
US

IV. Provider business mailing address

99 STORMS AVE UNIT 403
JERSEY CITY NJ
07306-4709
US

V. Phone/Fax

Practice location:
  • Phone: 615-519-5308
  • Fax:
Mailing address:
  • Phone: 615-519-5308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9139
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: