Healthcare Provider Details

I. General information

NPI: 1275782179
Provider Name (Legal Business Name): MARK M ZIMMERMANN LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 ELM ST APT W1304
BETHESDA MD
20814-3828
US

IV. Provider business mailing address

4710 ELM ST APT W1304
BETHESDA MD
20814-3828
US

V. Phone/Fax

Practice location:
  • Phone: 917-830-3463
  • Fax: 347-717-7750
Mailing address:
  • Phone: 917-830-3463
  • Fax: 347-717-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number081485
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR081485
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081485
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32135
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200003450
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: