Provider Demographics
NPI:1093823064
Name:ZIMMERMAN, JERROLD LEE (MSW)
Entity Type:Individual
Prefix:MR
First Name:JERROLD
Middle Name:LEE
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 MCWHORTER PL # B
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5605
Mailing Address - Country:US
Mailing Address - Phone:703-642-1112
Mailing Address - Fax:
Practice Address - Street 1:7330 MCWHORTER PL # B
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5605
Practice Address - Country:US
Practice Address - Phone:703-642-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040001781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical