Provider Demographics
NPI:1891855334
Name:NYGAARD, DEBRA DANENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:DANENE
Last Name:NYGAARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 JOCELYN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1807
Mailing Address - Country:US
Mailing Address - Phone:202-302-0400
Mailing Address - Fax:
Practice Address - Street 1:4000 ALBEMARLE ST NW
Practice Address - Street 2:SUITE 504
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1851
Practice Address - Country:US
Practice Address - Phone:202-302-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001703103TC0700X
DCPSY1000843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0026OtherCARE FIRST BCBS
DCBY52OtherCAREFIRST BC/BS
VA188487OtherANTHEM
VA004945026Medicaid
VA546001103002OtherTRICARE
VA270291OtherAMERIGROUP VIRGINIA INC.