Active NPI
Fredda Zuckerman, L.I.C.S.W.
- Mental Health Counselor
- Wellesley, MA
National Provider Identifier
1265509558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 103793
- Practice address
- 27 Mica LN
Suite 205
Wellesley, MA 02481-1724 - Phone
- (617) 921-4826
- NPI assigned
- Nov 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 103793 | MA | Primary |
Addresses
Primary practice location
27 Mica LN
Suite 205
Wellesley, MA 02481-1724
Mailing address
205 Mount Auburn St
Apt 2C
Cambridge, MA 02138-4864
Phone (617) 921-4826
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZUPO1835 | Other | MA | BLUCROSSBLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 2, 2018 through Jan 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103793 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460937600000",
"number": "1265509558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 MOUNT AUBURN ST",
"address_2": "APT 2C",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021384864",
"telephone_number": "617-921-4826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27 MICA LN",
"address_2": "SUITE 205",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024811724",
"telephone_number": "617-921-4826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUCKERMAN",
"first_name": "FREDDA",
"credential": "L.I.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2016-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "103793",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUCROSSBLUE SHIELD",
"identifier": "ZUPO1835",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wellesley, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.