Provider Demographics
NPI:1205235454
Name:CORINNE ZIMMER, PSYD LLC
Entity type:Organization
Organization Name:CORINNE ZIMMER, PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:CORINNE
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-426-0147
Mailing Address - Street 1:107 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3131
Mailing Address - Country:US
Mailing Address - Phone:321-426-0147
Mailing Address - Fax:321-327-7914
Practice Address - Street 1:107 N PALM AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3131
Practice Address - Country:US
Practice Address - Phone:321-426-0147
Practice Address - Fax:321-327-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty