Provider Demographics
NPI:1639221286
Name:ZIMMER, PETER LAWRENCE (MA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:LAWRENCE
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HAZARD AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4585
Mailing Address - Country:US
Mailing Address - Phone:860-324-1617
Mailing Address - Fax:860-749-5335
Practice Address - Street 1:139 HAZARD AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4585
Practice Address - Country:US
Practice Address - Phone:860-324-1617
Practice Address - Fax:860-749-5335
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000346101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor