Provider Demographics
NPI:1467621169
Name:ZUCKERMAN, MICHELLE SHERRI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SHERRI
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 MAIN ST APT G
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2346
Mailing Address - Country:US
Mailing Address - Phone:973-420-9705
Mailing Address - Fax:
Practice Address - Street 1:505 BOULEVARD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1603
Practice Address - Country:US
Practice Address - Phone:973-420-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4485103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical