Healthcare Provider Details

I. General information

NPI: 1093743528
Provider Name (Legal Business Name): MARC LEE ZIMMERMANN PH.D., M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 JUSTICE AVE
BATON ROUGE LA
70816-2373
US

IV. Provider business mailing address

PO BOX 86962
BATON ROUGE LA
70879-6962
US

V. Phone/Fax

Practice location:
  • Phone: 225-751-5412
  • Fax: 225-751-5847
Mailing address:
  • Phone: 225-293-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number304
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number304
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number304
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMPAP.000015
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: