Provider Demographics
NPI:1518970920
Name:ZINN, JUDITH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:ZINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LAUREL LANE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-367-9298
Mailing Address - Fax:516-367-9403
Practice Address - Street 1:366 NORTH BROADWAY
Practice Address - Street 2:STE LE4
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753
Practice Address - Country:US
Practice Address - Phone:516-932-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL0161311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN01431Medicare PIN