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General NPI Number Information
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NPI Number | 1881090660
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Entity Type | Individual
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Provider Name | TARA ZUCKERMAN PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 1501 NE 4TH AVENUE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304
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Country | US
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Telephone | 954-406-1366
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Fax | 561-852-3332
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Provider Business Mailing Address
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Address Line | 13655 MOSS AGATE AVENUE
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City | DELRAY BEACH
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State | FL
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Zip | 33446
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Country | US
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Telephone | 954-803-0022
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Fax | 561-852-3332
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8935
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License Number State | FL
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