Provider Demographics
NPI:1790500395
Name:ZIMMERMAN, CAITLIN (MS EDS II)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MS EDS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 CROOKED OAK DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6425
Mailing Address - Country:US
Mailing Address - Phone:814-229-8470
Mailing Address - Fax:
Practice Address - Street 1:20 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1950
Practice Address - Country:US
Practice Address - Phone:717-626-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9263237103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool