Provider Demographics
NPI:1891812673
Name:ZIEGELLAUB, MIRIAM RUTH (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:RUTH
Last Name:ZIEGELLAUB
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 1:525 W END AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3207
Mailing Address - Country:US
Mailing Address - Phone:212-580-5144
Mailing Address - Fax:
Practice Address - Street 1:525 W END AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3207
Practice Address - Country:US
Practice Address - Phone:212-580-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010398103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist