Provider Demographics
NPI:1003270505
Name:FEESE, MIRIAM RUTH BENJAMINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:RUTH BENJAMINA
Last Name:FEESE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:RUTH BENJAMINA
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736-0237
Mailing Address - Country:US
Mailing Address - Phone:530-217-8057
Mailing Address - Fax:
Practice Address - Street 1:20601 W PAOLI LN
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:CA
Practice Address - Zip Code:95736
Practice Address - Country:US
Practice Address - Phone:530-637-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA1010971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical