Healthcare Provider Details

I. General information

NPI: 1205753548
Provider Name (Legal Business Name): EMILY ROSE CYGRYMUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 PIKE ST STE 2
LEMONT PA
16851-9085
US

IV. Provider business mailing address

215 KENLEE DR APT 110
BELLEFONTE PA
16823-2806
US

V. Phone/Fax

Practice location:
  • Phone: 814-954-7607
  • Fax:
Mailing address:
  • Phone: 412-445-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS020680
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: