Provider Demographics
NPI:1245247691
Name:ZIMMERMAN, LYDIA ANN (MSW)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 NE 31ST CT APT 2503
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2679
Mailing Address - Country:US
Mailing Address - Phone:786-417-1922
Mailing Address - Fax:
Practice Address - Street 1:18181 NE 31ST CT APT 2503
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2679
Practice Address - Country:US
Practice Address - Phone:786-417-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW106551041C0700X
MI68010622691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical