Provider Demographics
NPI:1124183561
Name:HAMIDEH, MIRIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:HAMIDEH
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 1:31194 LA BAYA DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6431
Mailing Address - Country:US
Mailing Address - Phone:805-797-7875
Mailing Address - Fax:310-919-3755
Practice Address - Street 1:31194 LA BAYA DR STE 201
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6431
Practice Address - Country:US
Practice Address - Phone:747-222-7464
Practice Address - Fax:310-919-3755
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17320103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical