Provider Demographics
NPI:1699337436
Name:ZIMMERMAN, MARISA (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15509 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5456
Mailing Address - Country:US
Mailing Address - Phone:612-718-7041
Mailing Address - Fax:
Practice Address - Street 1:15509 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5456
Practice Address - Country:US
Practice Address - Phone:612-718-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2022-08-05
Deactivation Date:2021-11-05
Deactivation Code:
Reactivation Date:2022-08-05
Provider Licenses
StateLicense IDTaxonomies
MN174071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical