Provider Demographics
NPI:1639354160
Name:TSIMMERMAN, YEVGENIY (LCSW)
Entity type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:
Last Name:TSIMMERMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:YEVGENIY
Other - Middle Name:
Other - Last Name:TSIMMERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:PSYCHIATRY BOX 1268
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-987-7193
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:PSYCHIATRY BOX 1268
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-987-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078291-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical