Provider Demographics
NPI:1427652478
Name:ZYGMONT, NICOLE (MED, LBS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ZYGMONT
Suffix:
Gender:F
Credentials:MED, LBS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7002 W BUTLER PIKE FL 1
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5107
Mailing Address - Country:US
Mailing Address - Phone:215-285-3688
Mailing Address - Fax:844-966-0703
Practice Address - Street 1:654 N EASTON RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4310
Practice Address - Country:US
Practice Address - Phone:844-966-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004857103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst