Provider Demographics
NPI:1336200195
Name:ZEGMAN, MARILYN ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:ANN
Last Name:ZEGMAN
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 1:1253 WORCESTER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5208
Mailing Address - Country:US
Mailing Address - Phone:508-626-0568
Mailing Address - Fax:508-626-2750
Practice Address - Street 1:106 ANGELICA DR
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3641
Practice Address - Country:US
Practice Address - Phone:508-626-0568
Practice Address - Fax:508-626-2750
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3728103T00000X, 103TB0200X, 103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10407OtherBLUE CROSS SHIELD
0000031028OtherMANAGED HEALTH NETWORK
05153000OtherMAGELLAN
181987OtherVALUE OPTIONS
MA008239OtherHARVARD PILGRIM HEALTH CA
MAW03828OtherBLUE CROSS SHIELD
1041432OtherCIGNA
MA735669OtherTUFTS HEALTH PLAN
0000031028OtherMANAGED HEALTH NETWORK