Provider Demographics
NPI:1053599365
Name:ZIMMERMANN, LAURA A (LCSW-R CASWCM)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:LCSW-R CASWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3557
Mailing Address - Country:US
Mailing Address - Phone:718-779-1234
Mailing Address - Fax:718-799-7775
Practice Address - Street 1:6120 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3557
Practice Address - Country:US
Practice Address - Phone:718-779-1234
Practice Address - Fax:718-799-7775
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040912-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY47409COtherMEDICARE
NY00244624Medicaid
NY4740RWMedicare UPIN