Provider Demographics
NPI:1194747022
Name:ZUCKERMAN, STANLEY A (MSW)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:A
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 W HAYS STREET
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5028
Mailing Address - Country:US
Mailing Address - Phone:208-385-9200
Mailing Address - Fax:208-336-7125
Practice Address - Street 1:1408 W HAYS STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5028
Practice Address - Country:US
Practice Address - Phone:208-385-9200
Practice Address - Fax:208-336-7125
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW12191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical