Provider Demographics
NPI:1871901942
Name:ZUCCARO, KATHERINE (LMHC, MA, MED)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ZUCCARO
Suffix:
Gender:F
Credentials:LMHC, MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-4307
Mailing Address - Country:US
Mailing Address - Phone:516-698-9080
Mailing Address - Fax:516-584-6748
Practice Address - Street 1:28 E OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4292
Practice Address - Country:US
Practice Address - Phone:516-698-9080
Practice Address - Fax:516-584-6748
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YP2500X
NY005927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12749781OtherCAQH