Provider Demographics
NPI:1508288358
Name:ZIMMERMAN, MARYLYNN (CSW)
Entity Type:Individual
Prefix:MS
First Name:MARYLYNN
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 HWY 36
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2533
Mailing Address - Country:US
Mailing Address - Phone:732-291-0710
Mailing Address - Fax:732-291-2970
Practice Address - Street 1:1041 HWY 36
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2533
Practice Address - Country:US
Practice Address - Phone:732-291-0710
Practice Address - Fax:732-291-2970
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW04526400171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator