Provider Demographics
NPI:1427187715
Name:ZIMMERMAN, VINCENT GEORGE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:GEORGE
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 FIVE FORKS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7938
Mailing Address - Country:US
Mailing Address - Phone:217-793-3567
Mailing Address - Fax:
Practice Address - Street 1:512 FIVE FORKS DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7938
Practice Address - Country:US
Practice Address - Phone:217-793-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical