Healthcare Provider Details

I. General information

NPI: 1023611860
Provider Name (Legal Business Name): JANE ZVI KIMMELMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W 30TH ST
NEW YORK NY
10001-4406
US

IV. Provider business mailing address

9 LANCASTER AVE
MAPLEWOOD NJ
07040-1701
US

V. Phone/Fax

Practice location:
  • Phone: 212-725-7850
  • Fax: 212-967-4919
Mailing address:
  • Phone: 973-818-1925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: