Provider Demographics
NPI:1518218700
Name:ZIMMERMAN, JANE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:D
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 YORK AVE
Mailing Address - Street 2:16A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6855
Mailing Address - Country:US
Mailing Address - Phone:212-410-0494
Mailing Address - Fax:
Practice Address - Street 1:1735 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6855
Practice Address - Country:US
Practice Address - Phone:212-410-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010843-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical