Provider Demographics
NPI:1578633491
Name:ZYGMONT, JOANNA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:L
Last Name:ZYGMONT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:L
Other - Last Name:ACENTARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1389 BELDING ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-2301
Mailing Address - Country:US
Mailing Address - Phone:510-386-3632
Mailing Address - Fax:650-618-1902
Practice Address - Street 1:400 ESTUDILLO AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4900
Practice Address - Country:US
Practice Address - Phone:510-386-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFD718AMedicare PIN