Provider Demographics
NPI:1205693686
Name:ZIMMER, RYLEE CASSIDY (LCSW, LMSW, LGSW)
Entity type:Individual
Prefix:
First Name:RYLEE
Middle Name:CASSIDY
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:LCSW, LMSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 NEW YORK AVE NW APT 905
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4865
Mailing Address - Country:US
Mailing Address - Phone:940-456-0612
Mailing Address - Fax:
Practice Address - Street 1:850 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGSW104100000X
MD31166104100000X
MA228899104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker