MEDICARE: MR. ROBERT J ZIMA LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180007062	IL
2	101YP2500X	Professional Counselor	180007062	IL

General Provider Information

NPI Number	:	1306083902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT J ZIMA LCPC

Provider Business Mailing Address
First Line	:	1307 NEW HAVEN DR
Second Line	:
City	:	CARY
State	:	IL
Zip	:	60013-1805
Country	:	US
Telephone Number	:	847-322-4591
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 HERITAGE DR
Second Line	:	SUITE 1
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8068
Country	:	US
Telephone Number	:	847-322-4591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/19/2009

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