Healthcare Provider Details

I. General information

NPI: 1245351691
Provider Name (Legal Business Name): WILLIAM B ZUCKERMAN PH.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8987 COTSWOLD DR
BURKE VA
22015-1601
US

IV. Provider business mailing address

504 PENDLETON ST
ALEXANDRIA VA
22314-1904
US

V. Phone/Fax

Practice location:
  • Phone: 703-764-0700
  • Fax: 703-764-3068
Mailing address:
  • Phone: 703-548-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001150
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: