Stacey Zimmerman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

256077 Issued in KY

Practice address

340 Boatner Rd
Eglin AFB, FL 32542-1391

Phone

(850) 883-8600

NPI assigned

Feb 22, 2019

Last updated

May 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: staceyzimmerman@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Neurodiverse Therapy, LLC

  • Social Worker
  • Fort Knox, KY
  • NPI 1255020368

  FL

  Medicare reassignment NPD Authorized official
• Communicare Inc

  • Community/Behavioral Health Agency
  • Brandenburg, KY
  • NPI 1295872638
  Medicare reassignment NPD
• Therapeutic Transformations LLC

  • Community/Behavioral Health Agency
  • Bardstown, KY
  • NPI 1639682909
  Medicare reassignment
• Communicare Inc

  • Community/Behavioral Health Agency
  • Hodgenville, KY
  • NPI 1821419789
  NPD
• Communicare Inc

  • Community/Behavioral Health Agency
  • Radcliff, KY
  • NPI 1841337607
  NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1225595515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 BOATNER RD",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 BOATNER RD",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421391",
            "telephone_number": "850-883-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "STACEY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-22",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "256077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristofer Robert Yaple, PHARMD, BCPS
• Kristen Zachariah
• Michael Allan Zafft, PA-C
• Joseph Zamora Jr., PHARMD
• Michael Patrick Zeola, M.D.
• Heather Zimmie
• Michael Zipper, DO

• Clinical Social Worker in Eglin AFB, FL
• Providers in Eglin AFB, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.