Provider Demographics
NPI:1396953717
Name:ZIMMERMAN, JEFFREY LESLIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LESLIE
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT FRANCIS PL
Mailing Address - Street 2:6219
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1330
Mailing Address - Country:US
Mailing Address - Phone:415-222-9656
Mailing Address - Fax:
Practice Address - Street 1:21760 STEVENS CREEK BLVD
Practice Address - Street 2:102
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1170
Practice Address - Country:US
Practice Address - Phone:408-257-6882
Practice Address - Fax:408-257-0689
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10760103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical