Provider Demographics
NPI:1699406041
Name:ZIMMERMAN, BRUNO (LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:BRUNO
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3738
Mailing Address - Country:US
Mailing Address - Phone:203-263-3175
Mailing Address - Fax:
Practice Address - Street 1:670 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3738
Practice Address - Country:US
Practice Address - Phone:203-263-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health