Provider Demographics
NPI:1629097746
Name:ZUCKER, LARRY M (MSW)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:M
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 N LARCHMONT BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3753
Mailing Address - Country:US
Mailing Address - Phone:323-962-8190
Mailing Address - Fax:323-463-4489
Practice Address - Street 1:252 N LARCHMONT BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3753
Practice Address - Country:US
Practice Address - Phone:323-962-8190
Practice Address - Fax:323-463-4489
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS145961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical