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General NPI Number Information
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NPI Number | 1205235454
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Entity Type | Organization
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Legal Business Name | CORINNE ZIMMER, PSYD LLC
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 107 N PALM AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-3131
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Country | US
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Telephone | 321-426-0147
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Fax | 321-327-7914
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Provider Business Mailing Address
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Address Line | 107 N PALM AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-3131
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Country | US
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Telephone | 321-426-0147
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Fax | 321-327-7914
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. SHEILA CORINNE ZIMMER
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Credential | PSYD
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Telephone | 321-426-0147
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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 | PY 9080
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License Number State | FL
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