Provider Demographics
NPI:1447586060
Name:ZIMMERMANN, CAROL SHAY
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SHAY
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-6302
Mailing Address - Country:US
Mailing Address - Phone:575-546-0427
Mailing Address - Fax:
Practice Address - Street 1:501 W FLORIDA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-6302
Practice Address - Country:US
Practice Address - Phone:575-546-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM337446103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool