Provider Demographics
NPI:1578876827
Name:ZYGALA, KRISTEN TAMARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:TAMARA
Last Name:ZYGALA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021A EMMORTON RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8962
Mailing Address - Country:US
Mailing Address - Phone:410-569-5001
Mailing Address - Fax:
Practice Address - Street 1:2021A EMMORTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8962
Practice Address - Country:US
Practice Address - Phone:410-569-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0343668Medicaid