Provider Demographics
NPI:1528419843
Name:ZIMMERMAN, DELENA (MFTI)
Entity Type:Individual
Prefix:
First Name:DELENA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 35TH ST
Mailing Address - Street 2:APT A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-2350
Mailing Address - Country:US
Mailing Address - Phone:213-220-2150
Mailing Address - Fax:
Practice Address - Street 1:310 E 35TH ST
Practice Address - Street 2:APT A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-2350
Practice Address - Country:US
Practice Address - Phone:213-220-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF91360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist