Provider Demographics
NPI:1679103527
Name:ZIMMERMAN, LAURIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1554
Mailing Address - Country:US
Mailing Address - Phone:860-620-2478
Mailing Address - Fax:
Practice Address - Street 1:25 MAPLE ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1554
Practice Address - Country:US
Practice Address - Phone:860-620-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002658104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker