Provider Demographics
NPI:1619268794
Name:LISA ZUCKER, PA
Entity Type:Organization
Organization Name:LISA ZUCKER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PA
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:954-834-3570
Mailing Address - Street 1:3874 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3634
Mailing Address - Country:US
Mailing Address - Phone:954-834-3570
Mailing Address - Fax:
Practice Address - Street 1:3874 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3634
Practice Address - Country:US
Practice Address - Phone:954-834-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty