Provider Demographics
NPI:1003965252
Name:STEVENS, MIRIAM E (LMHC)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:E
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 NW 75TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4928
Mailing Address - Country:US
Mailing Address - Phone:954-829-0931
Mailing Address - Fax:954-742-5327
Practice Address - Street 1:1040 BAYVIEW DR
Practice Address - Street 2:SUITE 534
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2522
Practice Address - Country:US
Practice Address - Phone:954-829-0931
Practice Address - Fax:954-742-5327
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5977OtherBLUE CROSS BLUE SHIELD FL