Provider Demographics
NPI:1144383563
Name:ZUCKERMAN, PHILIP ALAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ALAN
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:ELDRED
Mailing Address - State:NY
Mailing Address - Zip Code:12732-5012
Mailing Address - Country:US
Mailing Address - Phone:845-557-6122
Mailing Address - Fax:
Practice Address - Street 1:45 CLARK RD
Practice Address - Street 2:
Practice Address - City:ELDRED
Practice Address - State:NY
Practice Address - Zip Code:12732-5012
Practice Address - Country:US
Practice Address - Phone:845-741-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW017984101YM0800X, 101YM0800X
NY049908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084114DBGMedicare ID - Type Unspecified