Provider Demographics
NPI:1700352416
Name:ZUKOWSKI, KIM ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:ANN
Last Name:ZUKOWSKI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 PALMGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3647
Mailing Address - Country:US
Mailing Address - Phone:480-734-1356
Mailing Address - Fax:805-493-4277
Practice Address - Street 1:853 PALMGROVE AVE
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3647
Practice Address - Country:US
Practice Address - Phone:480-734-1356
Practice Address - Fax:805-493-4277
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019730-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical