Provider Demographics
NPI:1184635971
Name:ZIEGLER, MAYA SUSANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:SUSANNA
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MAYA
Other - Middle Name:SUSANNA
Other - Last Name:LAEMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:28 WHITESANDS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1059
Mailing Address - Country:US
Mailing Address - Phone:949-644-0481
Mailing Address - Fax:949-833-3467
Practice Address - Street 1:1601 DOVE ST STE 230
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1423
Practice Address - Country:US
Practice Address - Phone:949-644-0481
Practice Address - Fax:949-833-3467
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical