Provider Demographics
NPI:1558490375
Name:ZUCKER, BONNIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:ZUCKER
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 1:11140 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3106
Mailing Address - Country:US
Mailing Address - Phone:301-881-8818
Mailing Address - Fax:301-881-8814
Practice Address - Street 1:11140 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 530
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3106
Practice Address - Country:US
Practice Address - Phone:301-881-8818
Practice Address - Fax:301-881-8814
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04008103TC0700X
DCPSY1000245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical