Provider Demographics
NPI:1497997225
Name:BETH ZUKOWSKI
Entity Type:Organization
Organization Name:BETH ZUKOWSKI
Other - Org Name:BETH ZUKOWSKI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-685-1701
Mailing Address - Street 1:150 SCHNOOR ROAD
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419
Mailing Address - Country:US
Mailing Address - Phone:860-685-1701
Mailing Address - Fax:
Practice Address - Street 1:150 SCHNOOR ROAD
Practice Address - Street 2:
Practice Address - City:KILLINGWORTH
Practice Address - State:CT
Practice Address - Zip Code:06419
Practice Address - Country:US
Practice Address - Phone:860-685-1701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005595314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility