Healthcare Provider Details

I. General information

NPI: 1710415666
Provider Name (Legal Business Name): KATELYN ANN ZMIGRODSKI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

9323 SHORE RD APT 6F
BROOKLYN NY
11209-6638
US

V. Phone/Fax

Practice location:
  • Phone: 800-836-6600
  • Fax:
Mailing address:
  • Phone: 347-645-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: