Provider Demographics
NPI:1598438038
Name:ZUKOR, TEVYA (PHD, LCP)
Entity Type:Individual
Prefix:DR
First Name:TEVYA
Middle Name:
Last Name:ZUKOR
Suffix:
Gender:M
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 GENTHER LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5297
Mailing Address - Country:US
Mailing Address - Phone:703-283-6195
Mailing Address - Fax:
Practice Address - Street 1:1809 GENTHER LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5297
Practice Address - Country:US
Practice Address - Phone:703-283-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical