Provider Demographics
NPI:1053454330
Name:ZIMMERMAN, CARLENE BETTY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:BETTY
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:BETTY
Other - Last Name:DAVIS ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3970 W DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-534-3358
Mailing Address - Fax:
Practice Address - Street 1:513 SE QUAPAW
Practice Address - Street 2:GRAND LAKE MENTAL HEALTH CENTER
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003
Practice Address - Country:US
Practice Address - Phone:918-337-8080
Practice Address - Fax:918-337-8099
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical