Provider Demographics
NPI:1205183506
Name:ZIMMERMAN, DIANE (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 WALNUT SHADE ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:DE
Mailing Address - Zip Code:19980
Mailing Address - Country:US
Mailing Address - Phone:302-684-4950
Mailing Address - Fax:302-684-8931
Practice Address - Street 1:823 WALNUT SHADE RD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:DE
Practice Address - Zip Code:19980
Practice Address - Country:US
Practice Address - Phone:302-684-4950
Practice Address - Fax:302-684-8931
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE53946103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool