Provider Demographics
NPI:1215357090
Name:ZIMMERMAN, EILEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 PEMBURN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3960
Mailing Address - Country:US
Mailing Address - Phone:917-612-9604
Mailing Address - Fax:
Practice Address - Street 1:34 EAST PUTNAM AVE SUITE 121
Practice Address - Street 2:
Practice Address - City:GREENWHICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:917-612-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0818071041C0700X
CT0086161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical