MEDICARE: LISA ZUCKER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW9233	OTHER	FL	LICENSED SOCIAL WORKER

General Provider Information

NPI Number	:	1558425629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ZUCKER LCSW

Provider Business Mailing Address
First Line	:	3874 SHERIDAN STREET
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3634
Country	:	US
Telephone Number	:	954-834-3570
Fax Number	:

Provider Business Practice Location Address
First Line	:	3874 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3634
Country	:	US
Telephone Number	:	954-834-3570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	04/19/2024

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