Provider Demographics
NPI:1619635109
Name:ZIMMERMAN, MARISSA (RBT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9361 MONTGOMERY RD STE B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7738
Mailing Address - Country:US
Mailing Address - Phone:513-492-2374
Mailing Address - Fax:
Practice Address - Street 1:9361 MONTGOMERY RD STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-7738
Practice Address - Country:US
Practice Address - Phone:513-492-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-19-88947106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician