Provider Demographics
NPI:1164088555
Name:ZIMMERMAN, LILA H
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:H
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 54TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2633
Mailing Address - Country:US
Mailing Address - Phone:347-529-8946
Mailing Address - Fax:
Practice Address - Street 1:1035 MARKET ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1665
Practice Address - Country:US
Practice Address - Phone:415-487-3100
Practice Address - Fax:415-558-9657
Is Sole Proprietor?:No
Enumeration Date:2019-05-12
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA122800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)