Provider Demographics
NPI:1811923048
Name:ZIMMERMAN, MARY (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:400 E RED BRIDGE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4035
Mailing Address - Country:US
Mailing Address - Phone:816-942-1811
Mailing Address - Fax:816-942-0419
Practice Address - Street 1:400 E RED BRIDGE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131
Practice Address - Country:US
Practice Address - Phone:816-942-1811
Practice Address - Fax:816-942-0419
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16068017OtherBCBSKC
MO4403292OtherAETNA
MO238878000OtherMAGELLAN
MO46809OtherCIGNA
MO6380108OtherUNITED HEALTCARE
MO64159OtherDEFINITY
MO10001565100OtherCHP
MO135587OtherVALUE OPTIONS