Provider Demographics
NPI:1306937990
Name:ZIMMER, CAROL A (LICSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:GOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:980 990 WASHINGTON ST
Mailing Address - Street 2:209
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-329-4774
Mailing Address - Fax:781-329-9153
Practice Address - Street 1:980 990 WASHINGTON ST
Practice Address - Street 2:209
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-329-4774
Practice Address - Fax:781-329-9153
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1115681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23932Medicare ID - Type Unspecified