Provider Demographics
NPI:1114765732
Name:ZIMMERMAN, MATTHEW (LMSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 FORT WASHINGTON AVE APT 32
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4651
Mailing Address - Country:US
Mailing Address - Phone:917-992-5365
Mailing Address - Fax:
Practice Address - Street 1:57 W BURNSIDE AVE FL B1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4038
Practice Address - Country:US
Practice Address - Phone:718-716-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker