Provider Demographics
NPI:1831268747
Name:ZIMBLER, IRA (LICSW)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:ZIMBLER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 MAIN STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2149
Mailing Address - Country:US
Mailing Address - Phone:518-755-9388
Mailing Address - Fax:
Practice Address - Street 1:780 MAIN STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2149
Practice Address - Country:US
Practice Address - Phone:518-755-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035681-11041C0700X
MA1058741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN0S131Medicare ID - Type Unspecified
MAPO6138Medicare PIN