MEDICARE: MR. PAUL ZUKAS 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	SW21105	FL

General Provider Information

NPI Number	:	1568152163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL ZUKAS LCSW

Provider Business Mailing Address
First Line	:	7635 ASHLEY PARK CT STE 503H
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6197
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7635 ASHLEY PARK CT STE 503H
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6197
Country	:	US
Telephone Number	:	321-972-4265
Fax Number	:	407-215-9436

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

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	05/09/2023

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