MEDICARE: NANNETTE NERO ZUKE, LMFT, LLC

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	106H00000X	Marriage & Family Therapist	MF1940	ME

General Provider Information

NPI Number	:	1700286721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANNETTE NERO ZUKE, LMFT, LLC

Provider Business Mailing Address
First Line	:	3 BOYNTON BROOK RD
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072-9379
Country	:	US
Telephone Number	:	207-985-5580
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 PORTLAND RD
Second Line	:	SUITE 6
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6650
Country	:	US
Telephone Number	:	207-985-5580
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER, MGR, OWNER
Name	:	NANNETTE A. NERO ZUKE
Credential	:	MS, CAGS, LMFT
Telephone Number	:	207-985-5580

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	08/27/2014

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