Provider Demographics
NPI:1700367521
Name:ZUCK, WILLIAM III (LICSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ZUCK
Suffix:III
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2527 CRANBERRY HWY STE D
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1144
Mailing Address - Country:US
Mailing Address - Phone:508-291-0049
Mailing Address - Fax:
Practice Address - Street 1:2527 CRANBERRY HWY STE D
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1144
Practice Address - Country:US
Practice Address - Phone:508-291-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW021921041C0700X
MA1155601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical