Provider Demographics
NPI:1609480839
Name:ZOOK, OMAR (LCSW)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ZOOK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 W CHOCOLATE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1663
Mailing Address - Country:US
Mailing Address - Phone:717-875-6087
Mailing Address - Fax:570-915-5355
Practice Address - Street 1:527 W CHOCOLATE AVE FL 2
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1663
Practice Address - Country:US
Practice Address - Phone:717-875-6087
Practice Address - Fax:570-915-5355
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-000643-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical