Provider Demographics
NPI:1215589486
Name:ZIMMERMANN, JENNIFER (LCADC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SPEAR RD STE 303
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1223
Mailing Address - Country:US
Mailing Address - Phone:551-655-8126
Mailing Address - Fax:
Practice Address - Street 1:19 SPEAR RD STE 303
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1223
Practice Address - Country:US
Practice Address - Phone:551-655-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37L00251100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty