Provider Demographics
NPI:1881268605
Name:ZIMMERMAN, REBECCA MARIE (MMTC, MT-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MMTC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 REED RD FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-4008
Mailing Address - Country:US
Mailing Address - Phone:484-450-6476
Mailing Address - Fax:
Practice Address - Street 1:390 REED RD FL 1
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4008
Practice Address - Country:US
Practice Address - Phone:484-450-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
17730225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health