Provider Demographics
NPI:1609914159
Name:ZIMMERMAN, GREGORY DEAN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEAN
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N HILLSIDE RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-9726
Mailing Address - Country:US
Mailing Address - Phone:413-665-3663
Mailing Address - Fax:
Practice Address - Street 1:110 N HILLSIDE RD
Practice Address - Street 2:SUITE 25
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9726
Practice Address - Country:US
Practice Address - Phone:413-665-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical