Healthcare Provider Details

I. General information

NPI: 1649476151
Provider Name (Legal Business Name): SUSAN ZIMMERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80-44 190 ST
JAMAICA ESTATES NY
11423
US

IV. Provider business mailing address

80-44 190 ST
JAMAICA ESTATES NY
11423
US

V. Phone/Fax

Practice location:
  • Phone: 718-479-6699
  • Fax: 718-776-6551
Mailing address:
  • Phone: 718-479-6699
  • Fax: 718-776-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR02567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: