Provider Demographics
NPI:1447817390
Name:ZIMMERMAN, JANA
Entity type:Individual
Prefix:DR
First Name:JANA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 OAKHURST RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1417
Mailing Address - Country:US
Mailing Address - Phone:207-344-8720
Mailing Address - Fax:
Practice Address - Street 1:40 FOREST FALLS DR STE 3
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-7005
Practice Address - Country:US
Practice Address - Phone:207-594-2952
Practice Address - Fax:888-714-5185
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1072103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty