Healthcare Provider Details

I. General information

NPI: 1619382975
Provider Name (Legal Business Name): PAULA L. ZIMMERMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MAIN AVE
ALBANY NY
12206-1821
US

IV. Provider business mailing address

160 N MAIN AVE
ALBANY NY
12206-1821
US

V. Phone/Fax

Practice location:
  • Phone: 518-437-6552
  • Fax: 518-437-6565
Mailing address:
  • Phone: 518-437-6552
  • Fax: 518-437-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001038
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: