Provider Demographics
NPI:1467576637
Name:ZIMMERMAN, JANE SIMON (MFT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:SIMON
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19343 SONOMA HWY
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-5445
Mailing Address - Country:US
Mailing Address - Phone:707-996-4312
Mailing Address - Fax:
Practice Address - Street 1:19343 SONOMA HWY
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-5445
Practice Address - Country:US
Practice Address - Phone:707-996-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC16708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health