Provider Demographics
NPI:1245492198
Name:ZUCKER, JO ANN (LCSW)
Entity type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:ZUCKER
Suffix:
Gender:F
Credentials:LCSW
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 412
Mailing Address - Street 2:
Mailing Address - City:TOMKINS COVE
Mailing Address - State:NY
Mailing Address - Zip Code:10986-0412
Mailing Address - Country:US
Mailing Address - Phone:845-786-2333
Mailing Address - Fax:845-786-2354
Practice Address - Street 1:4 TOMKISN DRIVE
Practice Address - Street 2:
Practice Address - City:TOMKINS COVE
Practice Address - State:NY
Practice Address - Zip Code:10986-0412
Practice Address - Country:US
Practice Address - Phone:845-786-2333
Practice Address - Fax:845-786-2354
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO164991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health