1508840752 NPI number — DR. RICHARD AVRAM ZUCKERWISE PHD, LCSW

Table of content: DR. RICHARD AVRAM ZUCKERWISE PHD, LCSW (NPI 1508840752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508840752 NPI number — DR. RICHARD AVRAM ZUCKERWISE PHD, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZUCKERWISE
Provider First Name:
RICHARD
Provider Middle Name:
AVRAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508840752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21243 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91364-2123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-999-6452
Provider Business Mailing Address Fax Number:
818-999-5912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21243 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91364-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-999-6452
Provider Business Practice Location Address Fax Number:
818-999-5912
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  LCS 10021 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3097332 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com