Provider Demographics
NPI:1164589214
Name:ZUCKERMAN, NORMA BOLTAN
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:BOLTAN
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 WHITERIM DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1787
Mailing Address - Country:US
Mailing Address - Phone:703-534-1031
Mailing Address - Fax:301-983-2252
Practice Address - Street 1:10921 WHITERIM DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1787
Practice Address - Country:US
Practice Address - Phone:703-534-1031
Practice Address - Fax:301-983-2252
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0904000786104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2U670353Medicare ID - Type Unspecified