Provider Demographics
NPI:1881430221
Name:ZIMMERMAN, ZISSEL (BCBA, MSED)
Entity type:Individual
Prefix:
First Name:ZISSEL
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:BCBA, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2813
Mailing Address - Country:US
Mailing Address - Phone:732-710-5162
Mailing Address - Fax:
Practice Address - Street 1:36 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-7034
Practice Address - Country:US
Practice Address - Phone:732-399-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-23-69171103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst