MEDICARE: MARTHA ZIMMERMANN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY5000054	MA
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1629720974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA ZIMMERMANN PHD

Provider Business Mailing Address
First Line	:	160 MARRETT RD
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-7015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 MAPLE AVE
Second Line	:
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-2732
Country	:	US
Telephone Number	:	781-572-2681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	02/05/2026

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