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General NPI Number Information
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NPI Number | 1851110563
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Entity Type | Organization
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Legal Business Name | DR DEMARCO ZUCKERBRAUN CONSULTING LLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 75 GRANITE ST STE 2C
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City | NEW LONDON
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State | CT
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Zip | 06320-5771
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Country | US
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Telephone | 860-581-0161
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Fax |
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Provider Business Mailing Address
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Address Line | 14 RIDGEWOOD RD
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City | NIANTIC
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State | CT
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Zip | 06357-2214
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Country | US
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Telephone | 860-581-0161
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GAIL DEMARCO ZUCKERBRAUN
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Credential | PHD
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Telephone | 860-581-0161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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