MEDICARE: TRUDY ANN ZIMMERMAN

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	104100000X	Social Worker	103791	MA

General Provider Information

NPI Number	:	1740767516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUDY ANN ZIMMERMAN

Provider Business Mailing Address
First Line	:	37 BROMFIELD RD
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-1311
Country	:	US
Telephone Number	:	508-523-6445
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 BAY STATE RD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-1403
Country	:	US
Telephone Number	:	617-353-7719
Fax Number	:

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

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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Directions to “ TRUDY ANN ZIMMERMAN ” Practice Location

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