Healthcare Provider Details

I. General information

NPI: 1336200195
Provider Name (Legal Business Name): MARILYN ANN ZEGMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ANGELICA DR
FRAMINGHAM MA
01701-3641
US

IV. Provider business mailing address

1253 WORCESTER RD SUITE 202
FRAMINGHAM MA
01701-5208
US

V. Phone/Fax

Practice location:
  • Phone: 508-626-0568
  • Fax: 508-626-2750
Mailing address:
  • Phone: 508-626-0568
  • Fax: 508-626-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3728
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3728
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3728
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number3728
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: