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General NPI Number Information
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NPI Number | 1033731146
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Entity Type | Individual
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Provider Name | MATTHEW STUART ZIMMERMAN PSY.D., ABPP
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Gender | Male
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 977 KELSEY DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-7855
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Country | US
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Telephone | 434-295-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 977 KELSEY DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-7855
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Country | US
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Telephone | 434-295-7757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810003528
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY10370
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License Number State | FL
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