Provider Demographics
NPI:1093743528
Name:ZIMMERMANN, MARC LEE (PHD, MP)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:LEE
Last Name:ZIMMERMANN
Suffix:
Gender:M
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86962
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-6962
Mailing Address - Country:US
Mailing Address - Phone:225-293-6377
Mailing Address - Fax:
Practice Address - Street 1:9270 SIEGEN LN
Practice Address - Street 2:SUITE 402
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1998
Practice Address - Country:US
Practice Address - Phone:225-293-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA304103TC0700X, 103TF0200X, 103TA0400X
LAMPAP.000015103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56167Medicare ID - Type Unspecified