Provider Demographics
NPI:1073137758
Name:ZUCKERMAN, STEPHANIE NICOLE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3273
Mailing Address - Country:US
Mailing Address - Phone:410-897-7499
Mailing Address - Fax:
Practice Address - Street 1:INTREPID STREET
Practice Address - Street 2:BLDG. S-771
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054
Practice Address - Country:US
Practice Address - Phone:901-874-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical