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General NPI Number Information
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NPI Number | 1346502069
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Entity Type | Organization
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Legal Business Name | SHAWN L. ZIMMERMAN, PHD, LLC
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 549 N WYMORE RD SUITE 209
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City | MAITLAND
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State | FL
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Zip | 32751-4203
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Country | US
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Telephone | 407-580-6997
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Fax | 407-628-9437
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Provider Business Mailing Address
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Address Line | 549 N WYMORE RD SUITE 209
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City | MAITLAND
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State | FL
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Zip | 32751-4203
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Country | US
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Telephone | 407-580-6997
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Fax | 407-628-9437
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAWN LEE ZIMMERMAN
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Credential | PHD
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Telephone | 407-580-6997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSYCHOLOGIST 2721
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH 9575
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License Number State | FL
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