Provider Demographics
NPI:1821016825
Name:ZUCKERMAN, LAWRENCE (EDD,MSW)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:EDD,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3607
Mailing Address - Country:US
Mailing Address - Phone:631-724-0212
Mailing Address - Fax:631-689-2084
Practice Address - Street 1:70 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3607
Practice Address - Country:US
Practice Address - Phone:631-724-0212
Practice Address - Fax:631-689-2084
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004603101YM0800X
NYPR-017507-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN04931Medicare ID - Type Unspecified