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General NPI Number Information
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NPI Number | 1558109942
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Entity Type | Individual
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Provider Name | MARK ZUCKERBROW
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Gender | Male
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Dates
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Enumeration Date | 07/18/2024
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 110 GOUGH ST STE 401
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-5971
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Country | US
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Telephone | 415-212-6478
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Fax |
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Provider Business Mailing Address
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Address Line | 472 38TH ST APT B
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City | OAKLAND
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State | CA
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Zip | 94609-2729
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Country | US
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Telephone | 917-561-6862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 159474
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License Number State | CA
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