Provider Demographics
NPI:1275080772
Name:WILLIAM B. ZUCKERMAN, PHD, PC
Entity Type:Organization
Organization Name:WILLIAM B. ZUCKERMAN, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAMJ
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-764-0700
Mailing Address - Street 1:8987 COTSWOLD DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1601
Mailing Address - Country:US
Mailing Address - Phone:703-764-0700
Mailing Address - Fax:703-764-3068
Practice Address - Street 1:8987 COTSWOLD DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1601
Practice Address - Country:US
Practice Address - Phone:703-764-0700
Practice Address - Fax:703-764-3068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001150261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health