| Stanley Zuckerman | |
|
1408 W Hays Street Boise ID 83702-5028 | |
| (208) 385-9200 | |
| (208) 336-7125 |
| Full Name | Stanley Zuckerman |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1408 W Hays Street, Boise, Idaho |
| Authorized Official Name and Position | Stanley A. Zuckerman (PSYCHOTHERAPIST) |
| Authorized Official Contact | 2083859200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stanley Zuckerman 1408 W Hays Street Boise ID 83702-5028 Ph: (208) 385-9200 | Stanley Zuckerman 1408 W Hays Street Boise ID 83702-5028 Ph: (208) 385-9200 |
| NPI Number | 1083636914 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 07/30/2020 |
| Certification Date | 07/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083636914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | LCSW1219 (Idaho) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | LCSW1219 (Idaho) | Secondary |
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