Provider Demographics
NPI:1720270382
Name:ZUKIC, LARISA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:LARISA
Middle Name:
Last Name:ZUKIC
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:10 BEACHES LANE
Mailing Address - City:SOUTH WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06267-0162
Mailing Address - Country:US
Mailing Address - Phone:860-428-4526
Mailing Address - Fax:
Practice Address - Street 1:10 BEACHES LANE
Practice Address - Street 2:10
Practice Address - City:SOUTH WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06267-0162
Practice Address - Country:US
Practice Address - Phone:860-428-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional