Provider Demographics
NPI:1306242557
Name:ZUCKERMAN, KARLIAN LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:KARLIAN
Middle Name:LEE
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SOUTH 900 EAST
Mailing Address - Street 2:UTAH CENTER FOR EVIDENCE BASED TREATMENT
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-419-0139
Mailing Address - Fax:
Practice Address - Street 1:164 SOUTH 900 EAST
Practice Address - Street 2:UTAH CENTER FOR EVIDENCE BASED TREATMENT
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-419-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
UT10098818-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other