Provider Demographics
NPI:1881090660
Name:ZUCKERMAN, TARA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13655 MOSS AGATE AVENUE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446
Mailing Address - Country:US
Mailing Address - Phone:954-803-0022
Mailing Address - Fax:561-852-3332
Practice Address - Street 1:1501 NE 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304
Practice Address - Country:US
Practice Address - Phone:954-406-1366
Practice Address - Fax:561-852-3332
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical