Provider Demographics
NPI:1043469703
Name:KEY, EDITH ZUCKERMAN (MA)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:ZUCKERMAN
Last Name:KEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 PARK ST. SUITE C
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-644-4214
Mailing Address - Fax:510-521-8253
Practice Address - Street 1:1242 PARK ST STE C
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5500
Practice Address - Country:US
Practice Address - Phone:510-644-4214
Practice Address - Fax:510-521-8253
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health