Provider Demographics
NPI:1437227915
Name:ZUCCARO, MICHAEL GERARDO (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GERARDO
Last Name:ZUCCARO
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734
Mailing Address - Country:US
Mailing Address - Phone:609-971-8989
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734
Practice Address - Country:US
Practice Address - Phone:609-971-8989
Practice Address - Fax:609-242-3207
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ445C002782001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S46771Medicare UPIN
NJ087679TQLMedicare ID - Type Unspecified