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General NPI Number Information
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NPI Number | 1750931986
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Entity Type | Individual
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Provider Name | JUSTIN ZIMMERMAN
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Gender | Male
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 6140 S BROADWAY
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City | LORAIN
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State | OH
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Zip | 44053-3891
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Country | US
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Telephone | 440-204-4273
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Fax |
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Provider Business Mailing Address
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Address Line | 6140 S BROADWAY
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City | LORAIN
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State | OH
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Zip | 44053-3891
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Country | US
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Telephone | 440-204-4273
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1904524
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License Number State | OH
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