Provider Demographics
NPI:1467684779
Name:ZIMMERLE, MARY E (PSYD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:ZIMMERLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1319
Mailing Address - Country:US
Mailing Address - Phone:415-448-7162
Mailing Address - Fax:
Practice Address - Street 1:2148A MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1319
Practice Address - Country:US
Practice Address - Phone:415-448-7162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27656103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical