Provider Demographics
NPI:1003374018
Name:BRISCOE, MIRIAM ELSIE (MFT)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ELSIE
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:LANDISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17040-0114
Mailing Address - Country:US
Mailing Address - Phone:207-659-8392
Mailing Address - Fax:
Practice Address - Street 1:103 WATER STREET
Practice Address - Street 2:
Practice Address - City:LANDISBURG
Practice Address - State:PA
Practice Address - Zip Code:17040-0114
Practice Address - Country:US
Practice Address - Phone:207-659-8392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25356106H00000X
PAMF000437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty