Provider Demographics
NPI:1073655361
Name:ZEIGLER, KENNETH DAVID (MSW LCSWC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DAVID
Last Name:ZEIGLER
Suffix:
Gender:M
Credentials:MSW LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 FOUNTAIN HILL DR
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-937-0925
Mailing Address - Fax:410-321-6176
Practice Address - Street 1:8600 LASALLE ROAD
Practice Address - Street 2:THE CHESTER BUILDING SUITE 325
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-321-6035
Practice Address - Fax:410-321-6176
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06999103T00000X, 104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD715FMedicare ID - Type Unspecified