Provider Demographics
NPI:1386189579
Name:ZIMMERMAN, REBECCA L (LCSW-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:WISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:ROOM PH291
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-4668
Mailing Address - Fax:410-938-5131
Practice Address - Street 1:8600 LASALLE RD.
Practice Address - Street 2:POTOMAC BLDG, SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-938-4668
Practice Address - Fax:410-938-5131
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical