Active NPI
Terri Lyn Zucker, PHD
- Clinical Psychologist
- San Mateo, CA
National Provider Identifier
1295982254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 25497
- Practice address
- 205 E 3Rd Ave
Ste 208
San Mateo, CA 94401-4051 - Phone
- (650) 759-2475
- Fax
- (650) 571-0747
- NPI assigned
- Aug 21, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 25497 | CA | Primary |
| Clinical Psychologist | 103TC0700X | 019719 | NY |
Addresses
Primary practice location
205 E 3Rd Ave
Ste 208
San Mateo, CA 94401-4051
Mailing address
13 12TH Ave
San Mateo, CA 94402-2401
Phone (650) 759-2475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130604000368 | CA | Practitioner - Psychologist Billing Independently | 8820236847 | Practice locations: Santa Cruz, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Santa Cruz, CA 95062
Phone (650) 759-2475
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019719 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382659200000",
"number": "1295982254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 12TH AVE",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944022401",
"telephone_number": "650-759-2475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 E 3RD AVE",
"address_2": "STE 208",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944014051",
"telephone_number": "650-759-2475",
"fax_number": "650-571-0747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUCKER",
"first_name": "TERRI",
"middle_name": "LYN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-21",
"last_updated": "2013-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "25497",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "019719",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.