Provider Demographics
NPI:1285285650
Name:CALLIA ZIMMERMAN LICSW LADC LLC
Entity type:Organization
Organization Name:CALLIA ZIMMERMAN LICSW LADC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW LADC
Authorized Official - Phone:802-393-8167
Mailing Address - Street 1:PO BOX 8114
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:VT
Mailing Address - Zip Code:05451-8114
Mailing Address - Country:US
Mailing Address - Phone:802-393-8167
Mailing Address - Fax:
Practice Address - Street 1:56 W TWIN OAKS TER STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7138
Practice Address - Country:US
Practice Address - Phone:802-393-8167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty