Provider Demographics
NPI:1265509558
Name:ZUCKERMAN, FREDDA (LICSW)
Entity Type:Individual
Prefix:
First Name:FREDDA
Middle Name:
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MOUNT AUBURN ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4864
Mailing Address - Country:US
Mailing Address - Phone:617-921-4826
Mailing Address - Fax:
Practice Address - Street 1:27 MICA LN
Practice Address - Street 2:SUITE 205
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1724
Practice Address - Country:US
Practice Address - Phone:617-921-4826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAZUPO1835OtherBLUCROSSBLUE SHIELD