Tina Rae Zimmerly, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

8601 W Emerald St Ste 130
Boise, ID 83704-8209

Phone

(208) 600-2184

NPI assigned

Jun 17, 2020

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

Other identifiers 1

Other names 1

• Tina Rae Mancuso Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1245856095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SUNSET DR",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979143121",
            "telephone_number": "541-889-9167",
            "fax_number": "541-889-7873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8601 W EMERALD ST STE 130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048209",
            "telephone_number": "208-600-2184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2609 S 10th Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836056885",
            "country_code": "US",
            "telephone_number": "208-454-2766",
            "fax_number": "208-454-2771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZIMMERLY",
        "first_name": "TINA",
        "middle_name": "RAE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-17",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO BOARD OF SOCIAL WORK EXAMINERS",
            "identifier": "LMSW-40409",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "MANCUSO",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ziqing Zhao, BA
• Gail L Zickefoose, LPC
• Pamela K. Ziegenfuss, S.W.
• Emily Grace Ziegler, MS, LPC
• Robert Keith Zigler, D.C.
• Joyce Ellen Zimmerman-Golden, NURSE PRACTITIONER
• Christian G Zimmerman, MD
• Jacob A Zimmerman, PH.D.
• Jessie Marie Zimmerman, PA-C
• Chelsea Zinke, MS

• Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.