Provider Demographics
NPI:1568544484
Name:ZUCKERMAN, JACKIE LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:LYNN
Last Name:ZUCKERMAN
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 1:3187 ANN ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4509
Mailing Address - Country:US
Mailing Address - Phone:516-236-9111
Mailing Address - Fax:516-223-0332
Practice Address - Street 1:3187 ANN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4509
Practice Address - Country:US
Practice Address - Phone:516-236-9111
Practice Address - Fax:516-223-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031960-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical