Provider Demographics
NPI:1366641359
Name:ZIMMERMAN, DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W END AVE
Mailing Address - Street 2:27H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5601
Mailing Address - Country:US
Mailing Address - Phone:917-940-4055
Mailing Address - Fax:
Practice Address - Street 1:425 EAST 58TH STREET
Practice Address - Street 2:SUITE 23F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2379
Practice Address - Country:US
Practice Address - Phone:917-940-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069193-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker