Provider Demographics
NPI:1275782179
Name:ZIMMERMANN, MARK M (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:ZIMMERMANN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 ELM ST APT W1304
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3828
Mailing Address - Country:US
Mailing Address - Phone:917-830-3463
Mailing Address - Fax:347-717-7750
Practice Address - Street 1:4710 ELM ST APT W1304
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3828
Practice Address - Country:US
Practice Address - Phone:917-830-3463
Practice Address - Fax:347-717-7750
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NYR0814851041C0700X
NY081485101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03366314Medicaid
NY1386005213OtherNPI