MEDICARE: DR. NANCY CORRAL ZIEBERT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4122	NJ

General Provider Information

NPI Number	:	1942325238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY CORRAL ZIEBERT PH.D.

Provider Business Mailing Address
First Line	:	90 MILLBURN AVE STE 202A
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1933
Country	:	US
Telephone Number	:	973-378-5525
Fax Number	:	973-378-5590

Provider Business Practice Location Address
First Line	:	90 MILLBURN AVE STE 202A
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1933
Country	:	US
Telephone Number	:	973-378-5525
Fax Number	:	973-378-5590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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