Provider Demographics
NPI:1760859185
Name:ZIMMERMAN, ELIZABETH (LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 KATONAH AVENUE
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2146
Mailing Address - Country:US
Mailing Address - Phone:914-401-8225
Mailing Address - Fax:
Practice Address - Street 1:223 KATONAH AVENUE
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2146
Practice Address - Country:US
Practice Address - Phone:914-401-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1818106H00000X
NY001349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008067800Medicaid
CT410001818CT01OtherANTHEM BCBS OF CT AWAKEN THE POWER THERAPY, LLC
CTNOT ELIGIBLEMedicare PIN
CT472092928OtherFEI BEHAVIORAL HEALTH AWAKEN THE POWER THERAPY, LLC
CTPENDINGOtherUBH-CONNECTICARE AWAKEN THE POWER THERAPY, LLC
CTPENDINGOtherUBH-OXFORD FREEDOM/LIBERTY AWAKEN THE POWER THERAPY, LLC
CT008067800Medicaid
CT008067800OtherCONNECTICUT BEHAVIORAL HEALTH PARTNERSHIP
CT472092928OtherTHREE RIVERS BEHAVIORAL HEALTH AWAKEN THE POWER, LLC
CT13837531OtherCAQH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH AWAKEN THE POWER THERAPY LLC