Provider Demographics
NPI:1295280295
Name:ZAMBRANO, KAREN MICHELLE (PSYD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
Last Name:ZAMBRANO
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 1:900 GRANGE HALL DR APT 6315
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-1979
Mailing Address - Country:US
Mailing Address - Phone:323-219-9109
Mailing Address - Fax:
Practice Address - Street 1:900 GRANGE HALL DR APT 6315
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-1979
Practice Address - Country:US
Practice Address - Phone:323-219-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1253103TS0200X
FLPY10585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
13878318OtherCAQH