Provider Demographics
NPI:1033731146
Name:ZIMMERMAN, MATTHEW STUART (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STUART
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 KELSEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-7855
Mailing Address - Country:US
Mailing Address - Phone:434-295-7757
Mailing Address - Fax:
Practice Address - Street 1:977 KELSEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-7855
Practice Address - Country:US
Practice Address - Phone:434-295-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003528103TC0700X
FLPY10370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical